Toxic multinodular goiter (MNG) involves an enlarged thyroid gland, is a common cause of hyperthyroidism and when it is accompanied by obstructive symptoms such as dyspnea, it carries an indication for surgery.
We present a case of 47-year old female with multinodular goiter with a rapid increase in size within 2 years. She also reported palpitation, breathlessness on exertion, tachycardia and hand tremor. Computed tomography scan of the neck shows a gross enlargement of thyroid gland across both sides of the neck. The fine needle aspiration cytology and final histopathological examination were suggestive of MNG with adenomatous nodules and toxic changes respectively. A total thyroidectomy was performed and the gland was dissected successfully.
Toxic MNG is most effectively treated by total thyroidectomy, which achieves complete diminution from symptoms.
Surgery for huge goiter is challenging and one should be careful about difficult intubation, altered anatomy and adhesions to the surrounding structures. Recognizing and treating this kind of cases are important, as they constitute a preventable cause of mortality if timely diagnosed and treated.

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