Management of a huge cystic multi-nodular goiter with retro-sternal extension. Case report

ABSTRACT Introduction and importance: Surgical management of huge multi-nodular goiters present clinical and surgical management dilemma among practicing surgeons. Thyroidectomies pose huge risk potential when performed by relatively inexperienced and junior operators. Case presentation: We present a case of a 40-year-old lady who had presented at our center with a ten-year history of painless anterior neck swelling. She was diagnosed with a multinodular goiter and underwent total thyroidectomy. Clinical discussion: Success of thyroid surgery depends upon operators' skill, training, experience, specialty and “thyroid volume surgery” index. Huge thyroid gland surgeries even to competent performers presents with challenges. The choice of type of thyroidectomy is still a dilemma among practicing surgeons. The employment of total thyroidectomy presents with risks of recurrent laryngeal nerve injury and parathyroid glands injury due to the nature of the radical dissection. However, it offers the advantage of complete resection of the diseased gland and alienates the chances of recurrence. Conclusion: It is the authors' opinion that total thyroidectomy for huge multi-nodular goiters is a safe procedure when performed by trained skilled surgeons and should be the standard for the management of multinodular goiters.