Critical Airway Obstruction Caused by a Giant Multinodular Goiter: Successful Management With Emergency Thyroidectomy

Acute airway obstruction secondary to a massive multinodular goiter represents a rare but critical surgical emergency, often occurring in patients with long-neglected thyroid disease. We report on an 85-year-old female who presented at Emergency County Hospital Tg Mures in March 2025 in critical respiratory distress, with documented tracheal deviation, orthopnea, and multiple episodes of cardiorespiratory arrest. Clinical and radiologic assessment revealed a giant anterior cervical mass with retrosternal extension and near-complete tracheal compression. Emergency airway control was achieved via awake fiberoptic intubation, followed by urgent total thyroidectomy. Intraoperative findings included significant tracheomalacia, prompting the need for concurrent tracheostomy. Postoperatively, the patient required intensive care monitoring and developed two systemic complications, a right hemispheric ischemic stroke and acute limb ischemia, both of which were managed conservatively. Histopathological analysis confirmed a benign multinodular goiter. This case emphasizes the importance of prompt recognition and surgical intervention in life-threatening compressive goiter, particularly in elderly patients, to prevent airway collapse and optimize outcomes.