Clinical characteristics of multinodular goiter causing tracheal compression

Multinodular goiter is a common benign thyroid disorder characterized by slow progression and often remains asymptomatic in many patients. Although substantial tracheal compression is rare, respiratory symptoms may be severe enough to require emergency medical evaluation and intervention. This study aimed to characterize the clinical presentation, airway management, surgical treatment and early postoperative outcomes of patients admitted to the emergency department with respiratory distress resulting from tracheal compression as a consequence of multinodular goiter.

A retrospective review of patients with symptoms of dyspnea and tracheal compression secondary to thyroid enlargement was conducted between January 2022 and 2025. Demographics, imaging, thyroid function tests, cytopathology, treatment, and outcomes of patients were analyzed. A total of 49 patients (26 females, 23 males, mean age 53 years) were included.

Multinodular goiter with tracheal narrowing and tracheal deviation was found in all cases by imaging. Thirty-three patients were euthyroid, nine had hyperthyroidism, and seven had hypothyroidism. The fine needle aspiration biopsies were mostly benign; however, eight patients were diagnosed with malignancy. In some cases, emergency airway management was required. The mean minimum tracheal diameter was 10.5 mm, and tracheal compression was associated with a thyroid lobe transverse dimension as small as 64 mm.

Large multinodular goiters may remain asymptomatic for prolonged periods before presenting with respiratory symptoms due to tracheal compression. Early imaging, recognition, and timely surgical treatment were considered essential. Further multicenter investigations are required to predict risk factors and optimize management strategies for patients at risk of tracheal compression.