A 67-year-old female presented for a post-thyroid surgery follow-up. She had undergone thyroid surgery in 2005 and now reported mild left-sided neck enlargement, though it did not cause significant pressure symptoms.

Laboratory tests revealed a TSH level of 1.09 mIU/L, FT4 of 15.3 pmol/L, and Anti-TPO of 10.9 IU/mL. Her thyroglobulin (Tg) was elevated at 141 ng/mL, while PTH was 43.6 pg/mL. Serum calcium was 9.05 mg/dL, and other routine blood tests, including CBC, blood urea, glucose, and viral screening, were normal.

Vocal cord assessment confirmed normal movement of both vocal cords, with no significant lesions detected.

Ultrasound of the thyroid revealed a mildly enlarged gland with heterogeneous echotexture and multiple well-defined nodules. The largest right lobe nodule measured 32x24x23 mm (TR3), while the largest left lobe nodule was 31x25x20 mm (TR3). Macrocalcifications were present in some nodules, and mild retrosternal extension on the left side was observed. There was no significant cervical lymphadenopathy.

CT scan of the neck, skull base, and upper chest showed enlarged thyroid lobes with multiple nodules, calcifications, and cystic degeneration. There was mild retrosternal extension (Grade I) but no tracheal displacement or stenosis. The carotid and jugular vessels were bilaterally displaced laterally. Additionally, a hyper enhancing nodule (17x13x9 mm) was detected at the left hyoid bone level, suggesting ectopic thyroid tissue or a suspicious lymph node.

The patient was diagnosed with recurrent multinodular goiter (MNG) with bilateral TR3 nodules and was scheduled for total thyroidectomy.

The patient underwent total thyroidectomy, and histopathological examination (HPE) confirmed multinodular goiter (MNG) with no evidence of malignancy.

The post-operative course was uneventful, and the patient was monitored for hormonal and calcium levels. She was scheduled for further follow-up to assess any residual or recurrent thyroid disease.