Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

Abstract

IntroductionBenign cervical goiters rarely cause acute airway obstruction.Case presentationWe report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression.ConclusionBenign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.

Acute respiratory failure caused by neglected giant substernal nontoxic goiter

“…Urgent thyroidectomy while rare is necessitated in cases of airway obstruction, both from benign and malignant causes, venous obstruction, and thyrotoxicosis with physiologic compromise (7,9,10). In cases of airway obstruction partial or total thyroidectomy relieved the symptoms (7). In the present case surgery lead to gradual symptoms subsidence and by the second day edema and cyanosis disappeared and oxygenation was also improved, but due to existing co-morbidities, never reached a satisfying level.…”

“…About 10% of these patients require emergency airway intubation (4), as in the present case. The causes of acute respiratory failure include upper respiratory tract infections resulting in edema and retention of secretions, sudden intrathyroidal hemorrhage, worsening of a medical illness, and tracheal stenosis or collapse (4,(7)(8)(9). In the present case we believe that the patient suffered from upper airway obstruction because of the giant substernal goiter and also from restrictive lung disease caused by morbid obesity.…”

“…The reported risk of malignancy ranges from 4% to 22% (3), but recent data suggest that the incidence of cancer in substernal goiters is no higher than in cervical goiters (1). Urgent thyroidectomy while rare is necessitated in cases of airway obstruction, both from benign and malignant causes, venous obstruction, and thyrotoxicosis with physiologic compromise (7,9,10). In cases of airway obstruction partial or total thyroidectomy relieved the symptoms (7).…”

“…While there is no consensus regarding the indications for thyroidectomy, substernal goiter should be treated surgically if it is symptomatic, if it does not respond to medical treatment, to prevent potential acute airway obstruction, especially in patients with compromised airflow identified by spirometry, and if malignancy is suspected in order to establish tissue diagnosis (3,4,6,7). The reported risk of malignancy ranges from 4% to 22% (3), but recent data suggest that the incidence of cancer in substernal goiters is no higher than in cervical goiters (1).…”

Acute airway obstruction due to benign asymptomatic nodular goiter in the cervical region: A case report

“…Acute airway obstruction due to retrosternal benign goiters or thyroid malignancies has been widely described, however, benign cervical goiters causing acute airway obstruction are rare (9). Deaths from such goiters due to, for example, suffocation by airway obstruction, should be prevented, considering that these are benign diseases which generally have a low mortality rate.…”