Massive multinodular goiter causing airway compression: A case series

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INTRODUCTION: Severe multinodular goiter (MNG) with extreme thyromegaly is a life-threatening condition due to airway and vascular compression. While rare, it demands a specialized, multidisciplinary approach to prevent catastrophic perioperative complications. This case series outlines a structured management protocol for this high-risk population. CASE PRESENTATION: We present three consecutive, eligible patients with severe MNG managed per a predefined protocol. All exhibited Pemberton's sign and > 70 % tracheal narrowing on imaging, with thyroid weights ranging from 800 g to 1.3 kg. Primary symptoms were progressive dyspnea, stridor, and thoracic inlet obstruction. DISCUSSION: A standardized protocol was employed, encompassing preoperative optimization (e.g., correcting thyrotoxicosis), computed tomography (CT) and laryngoscopy, awake fiberoptic intubation, total thyroidectomy with intraoperative neuromonitoring, and planned intensive care unit (ICU) surveillance. Despite the presence of difficult airways and tracheomalacia, all procedures were successful. All patients were followed for a minimum of 3 months, with documented resolution of symptoms. Histopathology confirmed benign MNG in all specimens, though the known malignancy risk in such goiters underscores the necessity for surgical intervention. CONCLUSION: Severe, airway-compromising MNG can be managed successfully with a meticulous, team-based strategy. Pemberton's sign and > 70 % tracheal narrowing should trigger urgent surgical referral. Our principles-emphasizing advanced airway planning, nerve monitoring, and postoperative vigilance-provide a practical framework for treating this high-risk population, particularly in resource-limited settings.

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