Imaging for Multinodular Goiter with Tracheal Compression

Initial Assessment of Multinodular Goiter

The American College of Radiology recommends ultrasound as the first-line imaging modality for suspected goiter, confirming thyroid origin and characterizing goiter morphology 1, 3
Ultrasound can identify nodules requiring biopsy based on suspicious features but has limitations in fully evaluating tracheal compression 2, 3
Tracheal compression due to goiters can lead to significant respiratory symptoms including dyspnea, orthopnea, obstructive sleep apnea, and stridor 4

CT scan is superior to ultrasound for evaluating the degree of tracheal compression, assessing substernal extension of the goiter, evaluating deep extension to the retropharyngeal space, and planning surgical approach when compression symptoms are present 1, 2
CT without IV contrast is usually sufficient for goiter evaluation unless there is concern for infiltrative neoplasm 2, 3

CT is preferred over MRI because there is less respiratory motion artifact, allowing for better assessment of tracheal compression 1, 2
CT more effectively defines the degree of tracheal compression compared to ultrasound, providing valuable information for surgical planning when compression symptoms are present 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends that the surgeon identify the recurrent laryngeal nerve during thyroidectomy to optimize voice outcomes and reduce risk of injury 5, 6
Removal of a large goiter may cause collapse of an already tracheomalacic airway, requiring careful perioperative management 6

A large, long-standing goiter may cause tracheal deviation that can complicate intubation during surgery, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 6