Abstract:

Multinodular goiter with retrosternal extension are seen in the superior and anterior mediastinum, but in 10-15% they can be found in the posterior mediastinum too. A large goiter may induce compressive symptoms. Thus, surgeries for such conditions require high levels of experience to avoid devastating complications, especially when the gland weighs <500g. Here we report the case of a 55-year-old lady who came with a swelling in the front of the neck which was insidious in onset and gradually progressed in size. She had history of breathing difficulties that worsened in the past month. On examination, a 5x5 cm firm swelling with an irregular surface in the left thyroid region moved with deglutition with no warmth or tenderness that deviated the trachea to the right; the lower border was not seen or palpable. No signs or symptoms of thyroid toxicity were seen. CT neck and chest showed a left-sided multinodular goiter with retrosternal extension, pushing the main cervical vessels posteriorly along with contact to the trachea and the right recurrent laryngeal nerve. The thyroid function test was normal. After assessments, the patient underwent total thyroidectomy via transcervical and sternotomy approaches. The patient recovered uneventfully and was discharged later. Presented in this case report is a not-so-large multinodular goiter in an euthyroid patient with retrosternal extension that had compression over the trachea and the main vessels along with right recurrent laryngeal nerve. The outcomes for this patient were discussed in light of the treatment options.

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