Multinodular Goiter and Airway Compression in a Preeclamptic Patient: A Unique Management Dilemma

Thyroid disease is relatively common among the general population, and certain thyroid conditions may be more common among pregnant women. These are usually hyperthyroid states. Additionally, the physiologic changes of pregnancy can mimic thyroid disease or cause a true remission or exacerbation of underlying disease. Indications for surgery in the pregnant patient include failure of medical management of thyrotoxicosis, compromise of the patient’s vision secondary to hyperthyroid orbitopathy or if obstructive enlargement causing airway compression is present. Acute airway comprise coupled with a complicated pregnancy is a rare occurrence. Management of these patients can be complex. We describe a patient who presented to our institution in her third trimester of pregnancy, with a large neck mass and worsening respiratory symptoms. Because these patients are generally young and healthy, they are usually able to compensate well which can delay the diagnosis of compressing masses or thyroid disease. Additionally, failure to prepare for possible complications in managing these patients can result in catastrophic outcomes.