Tracheomalacia following a total thyroidectomy in a patient with a large non-toxic goiter: A case report

Introduction: Nontoxic nodular goiter is one of the most prevalent thyroid conditions worldwide. Thyroidectomy for large goiters has a relatively high risk of postoperative airway obstruction, with tracheomalacia being one of the potential complications. Case report: A 61-year-old woman complained of a lump in her neck for 45 years. The node is progressively enlarged, but she did not experience any breathing difficulty, hoarseness, or pain while swallowing. A total thyroidectomy was then performed. The histopathologic examination revealed colloid goiter. During the procedure, evaluation of the trachea revealed a tracheomalacia, so a tracheotomy was then performed on the patient. After a follow-up period of three months, the patient was no longer experiencing tracheomalacia, and the tracheostomy was successfully closed. Discussion: Surgery has been considered an acceptable approach for managing non-toxic goiter. The most common indications are compressive symptoms, substernal extension, inability to control hyperthyroidism through medication, and a suspicion of malignancy. However, thyroidectomy for large goiter carries a relatively high risk of postoperative respiratory obstruction. Diagnosing tracheomalacia can be challenging and often relies on bronchoscopy to assess the airway and observe the collapse of cartilage and membranes. Acquired tracheomalacia can be managed through internal or external stenting or tracheostomy. Conclusion: Total thyroidectomy has been recommended as a suitable procedure for non-toxic and toxic multinodular goiter. Tracheomalacia may occur following thyroidectomy in patients with thyroid enlargement. Tracheostomy effectively manages tracheomalacia by creating a channel across the malacia's focal segment, restoring the airway's patency.