A massive multinodular goiter with retrosternal extension and compressive symptoms was treated by thyroidectomy, with benign nodular disease on histology.
A middle-aged patient with a 10-year thyroid history presented with progressive neck swelling and dysphagia. He also had hypertension and heart disease, used carbimazole, propranolol, concor and torsicalm, and reported no prior surgery or drug allergies.
TSH 1.57 uIU/mL, FT4 8.54 pmol/L and TRAb below 0.800 IU/L supported a non-autoimmune pattern; thyroglobulin was above 500 ng/mL and calcium was normal. Ultrasound showed marked bilateral thyroid enlargement with multiple TR3 nodules and retrosternal extension. CT confirmed a large heterogeneous multinodular thyroid mass with calcification, cystic degeneration and extension nearly to the tracheal carina.
Because of the retrosternal extension, compressive symptoms and risk of progression, thyroidectomy was performed. Intraoperative findings were consistent with a massive bilateral goiter with deep mediastinal descent.
Histology showed thyroid follicular nodular disease with benign secondary changes and no malignancy.
Postoperative recovery was smooth, with improved airway symptoms and no reported hypocalcaemia or nerve injury. Thyroid hormone replacement and continued surveillance were advised.
