title: Emergency thyroidectomy: Due to acute respiratory failure.
abstract: BACKGROUND
  Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.
  
  
  METHODS
  A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.
  
  
  CONCLUSIONS
  In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.
  
  
  CONCLUSIONS
  Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: zulfubayhan@gmail.com.
authors.forename: Zulfu
authors.initials: Z
authors.lastname: Bayhan
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: sezginzeren@gmail.com.
authors.forename: Sezgin
authors.initials: S
authors.lastname: Zeren
authors.affiliation: Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: bercis.imge@gmail.com.
authors.forename: Bercis Imge
authors.initials: BI
authors.lastname: Ucar
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: isaozbay@gmail.com.
authors.forename: Isa
authors.initials: I
authors.lastname: Ozbay
authors.affiliation: Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: dryalcinsonmez@gmail.com.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Sonmez
authors.affiliation: Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: metinmestan@gmail.com.
authors.forename: Metin
authors.initials: M
authors.lastname: Mestan
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey. Electronic address: obalabandr@gmail.com.
authors.forename: Onur
authors.initials: O
authors.lastname: Balaban
authors.affiliation: Department of Anesthesiology and Reanimation, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: niluferaraz@gmail.com.
authors.forename: Nilufer Araz
authors.initials: NA
authors.lastname: Bayhan
authors.affiliation: Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey. Electronic address: mfatihekici@gmail.com.
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Ekici
keywords: Awake intubation; Giant goiter; Laryngotracheal compression; Respiratory failure; Retrosternal; Thyroidectomy