Giant multinodular goiter with Grave’s disease associated with retrosternal extension: a case report of thyroid-related emergency

Abstract

Introduction and importance: Although huge multinodular goiter is a common underlying etiology of hyperthyroidism, retrosternal extension occurs only in up to 7% of instances. Giant goiter is an unusual phenomenon that creates surgical challenges. Case presentation: A 48-year-old female, with a background history of Graves with toxic multinodular goiter, presented with a two-day history of tachycardia and a new onset of atrial fibrillation. On admission, the patient had an enlarged diffused neck mass associated with dyspnea and hoarseness of voice, with no evidence of other compressive symptoms. The patient has a 7-year history of thyrotoxicosis that was managed by medical treatment. The diagnosis of huge multinodular goiter and Graves’ disease was confirmed by laboratory investigations and both ultrasonography and computed tomography (CT) of the neck. Then, the patient’s recent presentation necessitates the performance of a total thyroidectomy to manage the emergency situation. The resected specimen was sent for histopathology studies, and the postoperative period was uneventful. Clinical discussion: Giant goiter with retrosternal extension is rarely reported by physicians. The clinical manifestations of huge goiter include compressive symptoms and/or thyroid dysfunction. Diagnosis of goiter relies on imaging modalities. Neck CT was used to diagnose the majority of cases. Total thyroidectomy provides the definitive treatment of massive multinodular goiter. Conclusion: Because long-term huge goiter is a life-threatening condition, the authors highlight a case of a 48-year-old female patient who presented with a massive thyroid goiter and Graves’ disease that was found to require total thyroidectomy to manage the clinical features.