Surgical Management of Giant Toxic Multinodular Goiter with Compressive Symptoms in Setup with Scarce Resources: A Case Report

Abstract

Introduction: Toxic multinodular goiter (TMNG) usually occurs in older individuals, who often have a lengthy history of nontoxic multinodular goiter. The cases of giant multinodular goiter are rare clinical conditions nowadays. Thyroidectomy is generally the preferred treatment option because it resolves both toxic and compressive symptoms. Case Report: We present here a case of giant toxic multinodular goiter successfully treated at Dessie comprehensive specialized hospital. A 60-year-old female presented with anterior neck swelling of 30 years and toxic symptoms of 3 years duration. She had breathing difficulty in a supine position. On physical examination, there was a huge anterior neck mass measuring 27×24 cm in the largest dimensions. Based on TFT, FNAC, and ultrasound, she was diagnosed with a giant toxic multinodular goiter. After medical treatment with antithyroid drugs, a total thyroidectomy was performed and the gland was dissected successfully. Discussion: The most effective treatment of giant toxic multinodular goiter is total thyroidectomy which avoids recurrence and subsequent complication rates with repeat surgery. Conclusion: Due to difficulty during intubation, the presence of altered anatomy, and adhesions to the surrounding structures associated with giant toxic MNG, it will be a challenge to do a thyroidectomy.