Humongous mediastinal goiter: Interesting case report with its management challenges

Goiters with mediastinal extension are very rare. Occasionally they necessitate thoracic exploration for complete surgical excision which may be associated with serious complications. A 50-year-old man presented with a simple multinodular goiter and huge thoracic extension. After adequate investigative workup and optimal preoperative preparation, he underwent successful total thyroidectomy via combined cervicotomy and complete sternotomy. The excised goiter was 1.85 kg in weight and 20 × 25 × 18 cm in dimensions occupying entire anterosuperior mediastinum and 60% of left pleural cavity. Postoperative recovery was uneventful with no major morbidity. Rarely, giant thoracic extensions such as this case can be encountered. We are arguably reporting one of the largest thoracic goiters ever reported.