Grade IV Macronodular Goiter with Euthyroidism

Introduction: Nowdays, nodular goiter affects millions of people around

the world. In recent years, there has been a worldwide debate on whether benign
nodular goiter should be treated with total thyroidectomy or with a subtotal
procedure. The major arguments are: first, no further surgery will be needed in
case histological examination reveals an incidental microcarcinoma. Second, total
thyroidectomy eliminates the risk of recurrent goiter and with it, the potential need
for another intervention, which has a significantly higher rate of postoperative
problems than the initial surgery.
Case report: We present a case of a 67-year-old male patient with long-
standing, painless, palpable bilateral thyroid mass. He was clinically euthyroid and
had a palpable, mobile left lobe (Grade 1). The most effective way of diagnosis
was ultrasonography, that revealed grade IV macronodular goiter (LL>RL). LL
was completely occupied by a heterogeneous macronodule, with areas of cystic
degeneration, measuring 4 cm. The RL showed in the middle and lower 1/3,
another macronodule, well delimited, with central macrocalcifications, dived into
the upper mediastinum, measuring 3 cm. Her serum was T3 free, T4 free and TSH,
PTH, antithyroid antibody (ATPO) and antithytoglobulin antibody (ATG) levels at
normal range. Our patient underwent a total thyroidectomy with the identification
and management of bilateral recurrent nerves. Evolution postoperative was
favorable. The ORL consultation performed preoperatively and postoperatively
revealed normal functions.
Discussions: Among other reasons of total thyroidectomy in euthyroid
patients with thyroid macronodule there are also included: compression of trachea
and esophagus, significant growth of the nodule, neck discomfort and cosmetic
concern.
Conclusions: In conclusion, the ability to differentiate these nodules from
metastatic adenopathies of differentiated thyroid carcinoma has substantial
therapeutic and prognosis consequences, as well as the potential to save
unnecessary surgery.

Key words: total thyroidectomy, microcarcinoma, euthyroidism, TSH, PTH.