Recurrent Multinodular Goiter in a 61-Year-Old Female

Case Presentation:
A 61-year-old female presented to the Smart Surgical Team with a recurrent large goiter, which she had previously undergone surgery for 30 years ago. Her past medical history was unremarkable, and her only surgical history was the previous thyroid surgery. She was on Thyroxine 100mcg twice per week.

Examination:
On examination, a large firm nodule was palpated in the neck, classified as G3. There was no change in voice and no signs of hypocalcemia.

Laboratory Findings:

• TSH: 0.6 µIU/ml (Normal)

• Free T4: 15.91 pmol/L (Normal)

• ATPO: 12 IU/ml (Normal)

• Thyroglobulin: >500

• Calcium: 9.07 mg/dl (Normal)
  

Imaging:
Ultrasound findings revealed:

• Right lobe remnant: 68 × 36 × 32 mm, mildly enlarged with multiple nodules, the largest measuring 31 × 23 × 18 mm.

• Left lobe remnant: 100 × 58 × 50 mm, moderately enlarged with multiple nodules, the largest measuring 45 × 37 × 30 mm.

• Mild retrosternal extension was noted.
  
  

Vocal Cord Check:
The vocal cord examination was normal.

Management Plan:
After evaluation by the anaesthesiologist and vocal cord assessment, the decision was made to proceed with surgery. The patient’s medication was stopped prior to surgery.

Under general anesthesia, the procedure was performed through a midline collar skin incision. The upper and lower flaps were raised, and a midline incision was made. The strap muscles were retracted laterally, and both thyroid lobes were exposed. The bilateral recurrent laryngeal nerves (RLN) were identified and preserved. The upper and lower parathyroid glands were preserved, and hemostasis was secured. A Redivac drain was placed, and the skin was closed in layers.

Postoperative Course:
The postoperative course was uneventful, and the patient was discharged home 24 hours after surgery.

Image Gallery