Recurrent Nodular Goiter

A 55-year-old man had undergone bilateral subtotal thyroidectomy due to multinodular goiter 30 years ago, and histopathological examination had revealed benign nodular goiter. The patient had been suffering from swelling in the neck and dyspnea for the last 15 years, and the symptoms got worsened by the time. The thyroid ultrasonography revealed a diffusely enlarged thyroid gland, with the right lobe being 11 × 8 × 4 cm, left lobe being 5.5 × 4.5 × 3 cm, and extension to the retrosternal region. He was referred for surgery. The operation was initiated with an enlarged Kocher’s incision on the neck. The retrosternal portion of thyroid could not be removed through the neck incision, and thus, partial sternotomy was performed. The definitive treatment of recurrent goiter is primarily surgery. However, adhesions and scar tissue due to previous neck surgery increase the risk of complications during recurrent surgery. The rate of complications increases with the rising number of reoperations. It is essential to find the recurrent laryngeal nerve at the earlier stages of surgery and to give considerable attention to protect it during surgery. Intraoperative nerve monitorization should be used for preservation of recurrent laryngeal nerve. Careful dissection and attentive identification and preservation of parathyroid glands, as well as recurrent laryngeal nerves, should be performed during surgery.