Journal of Anesthesiology & Clinical Science
Background: Worldwide, endemic goiter is prevalent and is often caused by inadequate iodine intake. On the other hand, iodine may
not be deficient in some parts of the world, yet goiters still occur due to the presence of goitrogens in the diet which eventually leads to
the thyroid gland enlargement by interfering with normal production of thyroid hormone. In Sub-Saharan Africa, iodine deficiency is
widespread and is of public health concern. However, limited diagnostic and management possibilities in this area often result in long
standing goiters which eventually develops into large goiters that consequently compress the airway.
Case presentation: A 74-year-old woman diagnosed with multi nodular goiter was anesthetized for sub-total thyroidectomy. The
goiter was large and multi nodular in nature, pushing the trachea to the left side of the neck. This subsequently led to tracheal
compression, narrowing, and deviation. During induction of general anesthesia, intubation using flexible fibreoptic bronchoscopy
techniques was impossible. Tracheal intubation was achieved via tracheostomy using size 7-mm cuffed endotracheal tube. We present
this case at length and describe how the airway was secured during and after surgery.
Conclusion: Airway management for thyroidectomy involving large goiters with severely compromised airways could be considered
for tracheostomy in most hospitals in developing countries where advanced anesthesia equipment are not readily available.
Key words: Multinodular goiter, airway, thyroidectomy, intubation, tracheostomy