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\begin{document}

\title{Giant Multinodular Goiter since 24 years; hidden in a village of Western
Nepal}



\author[1]{Brihaspati Sigdel}%
\author[2]{Bhima Neupane }%
\author[3]{Amrit Pokhrel}%
\author[4]{Prakash Nepali}%
\affil[1]{Gandaki Medical College Teaching Hospital and Research Center Pvt Ltd}%
\affil[2]{Manipal College of Medical Sciences}%
\affil[3]{Metrocity Hospital Private Limited}%
\affil[4]{Bhimad Primary Health Care Centre}%


\vspace{-1em}



  
  \date{March 12, 2025}


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\selectlanguage{english}
\begin{abstract}
Here we present the case of giant multinodular goiter with retrosternal
extension in an old lady with dyspnea for 3 months. The patient was
treated with Microscopic assisted thyroidectomy without complication.%
\end{abstract}%



\sloppy


\textbf{Giant Multinodular Goiter since 24 years; hidden in a village of
Western Nepal}

Brihaspati Sigdel\textsuperscript{1}, Bhima Neupane\textsuperscript{2},
Amrit Pokhrel\textsuperscript{3}, Prakash Nepali\textsuperscript{4}

\textsuperscript{1}Professor and Head, Department of Otolaryngology \&
Head and Neck Surgery, Gandaki Medical College \& Consultant ENT
Surgeon, Metrocity Hospital, Pokhara, Nepal

\textsuperscript{2}Lecturer, Department of Anatomy, Manipal College Of
Medical Sciences, Pokhara, Nepal.

\textsuperscript{3}Medical Officer, Metrocity Hospital, Pokhara, Nepal

\textsuperscript{4}Medical Officer , Bhimad Primary health centre,
Bhimad , Tanahun,Nepal

\textbf{Correspondence to;}

Dr. Brihaspati Sigdel

Professor \& Head of Department

Department of Otolaryngology \& Head and Neck Surgery

Gandaki Medical College Teaching Hospital, Pokhara, Nepal.

Consultant ENT Surgeon , Metrocity Hospital , Pokhara, Nepal

Email: brihassig1@gmail.com

Phone No: 009779856030090

https://orcid.org/0000-0002-8546-6699

\textbf{Case Report}

A 67-year-old lady presented at the health camp organized in the kihun
village by Bhawana Foundation, Nepal with complaints of Painless neck
swelling for 24 years and shortness of breath since 3 months.. On neck
Examination, huge mass was present more on left side. The mass was
non-tender, non-pulsatile, that moved with deglutition.(Fig. 1)

Thyroid function tests and serum calcium were within normal limits.
Ultrasound of the neck showed multiple nodules and cystic lesions in the
whole gland. The CECT neck revealed heterogeneously enhancing lesions
extending retrosternally.(Fig. 2A and 2B). FNAC suggestive of atypia of
undetermined significance (AUS).

The patient underwent microscopic assisted total thyroidectomy under
general anesthesia. Her post-operative recovery was uneventful and
relieves her shortness of breadth. The patient was discharged on the
sixth postoperative with levothyroxine replacement therapy. The mass
removed from the neck was 461.5 grams and measured approximately 14 cm.
(Fig.3).Microscopic Examination consists with multinodular goitre.

Benign multinodular goiter leading to airway compromise has become a
rare clinical entity. \textsuperscript{1}Universal salt iodization,
cosmetic concern, and improved surgical technique with minimal
disfigurement have led to the disappearance of monstrous goiter from
modern clinical practice. The definitive management of multinodular
goiter includes total thyroidectomy.\textsuperscript{2}

\textbf{Acknowledgement:} None

\textbf{Conflict of Interest}

We declare no competing interests.

\textbf{Contributors}

BS involved in diagnosis, treatment and conceptualization of study. BS,
BN, AP, and PN involved in manuscript preparation, editing and proof
reading of final version of manuscript

\textbf{Consent.} Written Informed consent was obtained from the patient
to publish this report.

References

Kumar KV, Saini M, Kapoor U, Banga P. Massive multinodular goiter with
stridor. Indian J Endocrinol Metab. 2012 Jul;16(4):664-5. DOI:
10.4103/2230-8210.98043. PMID: 22837944.

Makay \selectlanguage{ngerman}Ö. Less than total thyroidectomy for goiter: when and how? Gland
Surg. 2017;6(1):S49-S58. DOI: 10.21037/gs.2017.10.02. PMID: 29322022.

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