Pune: A 54-year-old woman suffering from a large toxic multinodular goitre and long-standing hyperthyroidism has successfully undergone total thyroidectomy at Medicover Hospital, Bhosari, Pune, after developing breathlessness on exertion and a change in voice.
Mrs. Sunita Fatangare had been living with hyperthyroidism and was on anti-thyroid medication. However, the progressive enlargement of her thyroid gland resulted in a large multinodular swelling accompanied by exertional breathlessness and voice changes, prompting doctors to recommend definitive surgical treatment.
The complex case was managed at Medicover Hospital, Bhosari, under the care of Dr. Ashish Shahurao Bangar, Consultant – Surgical Oncology, along with Dr. Shirish Shelke, Consultant – ENT, with multidisciplinary support from endocrinology, critical care and anaesthesia teams.
Given the size of the goitre and associated airway concerns, extensive pre-operative evaluation was undertaken. Thyroid function, calcium, phosphorus, magnesium and vitamin D levels were assessed, along with cardiac and anaesthetic fitness. The possible risks, including airway complications, voice changes, recurrent laryngeal nerve injury, hypocalcaemia and the need for prolonged ventilatory support, were discussed with the patient and her family.
The patient underwent total thyroidectomy successfully. Following surgery, she was shifted to the ICU at Medicover Hospital for close airway monitoring and initially required ventilatory support. After a planned weaning trial, she was successfully extubated.
Her recovery was closely monitored for airway compromise, bleeding, voice changes and calcium disturbances. Her voice improved after surgery and she gradually resumed oral intake.
During the post-operative period, she developed tingling in her hands and a positive Chvostek sign, suggesting early hypocalcaemic symptoms. The condition was promptly identified through clinical monitoring and ionised calcium assessment and was managed with calcium supplementation and calcitriol. Her condition subsequently stabilised.
The surgical drain was removed after the output reduced, and the patient was discharged in stable condition with good wound healing, improved voice and satisfactory oral intake.
Dr. Ashish Shahurao Bangar said, “Large toxic multinodular goitres can present significant surgical and airway challenges, particularly when patients develop compressive symptoms such as breathlessness and voice changes. In such cases, careful pre-operative optimisation, multidisciplinary planning and meticulous surgery are essential. Equally important is vigilant post-operative monitoring, as complications such as hypocalcaemia can develop even after an otherwise successful procedure. Early recognition and timely treatment helped us achieve a satisfactory recovery in this patient.”
The case highlights the importance of a coordinated multidisciplinary approach at Medicover Hospital, Bhosari, Pune, in managing patients with large toxic multinodular goitres, particularly when compressive symptoms and potential airway challenges are present.
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