Neglected massive multinodular goiter during pregnancy with dyspnea and successful normal delivery: A case report.

KEY CLINICAL MESSAGE: Prompt coordinated care enables vaginal delivery for severe goiter-induced airway compression in late pregnancy when expectant management is precluded.

ABSTRACT: Long-standing neglected multinodular goiter rarely causes life-threatening airway compression in late pregnancy. Most cases report cesarean delivery to relieve respiratory distress. Vaginal birth may also be possible, but the evidence is limited. A 30-year-old woman with a 7-year goiter history developed severe dyspnea at 34 weeks gestation. Despite the risks, labor was induced by urgent decompression. She vaginally delivered a premature but healthy infant. Her breathing improved after delivery. She later underwent an uncomplicated thyroidectomy. With careful selection and monitoring, vaginal delivery can be considered for goiter-induced respiratory compromise when expectant management is precluded. This case demonstrates successful urgent decompression and favorable maternal-fetal outcomes are possible with a coordinated approach despite the high-risk scenario.