Airway obstruction, caesarean section and thyroidectomy

Airway obstruction in pregnancy is rare. We report the case of a 39-year-old nulliparous woman with a body mass index of 47 kg/m2 and a large multinodular goitre causing tracheal compression with airway symptoms who declined thyroid surgery until after delivery. However, worsening hypertension precipitated an urgent caesarean section and thyroidectomy at 32 weeks of gestation. As general anaesthesia was required, an awake fibreoptic intubation via the oral route was felt to be the safest option. Caesarean section was performed and a healthy baby delivered followed by a total thyroidectomy. She was extubated, monitored closely for tracheomalacia and cared for postoperatively in the surgical high-dependency unit. This case highlighted a number of challenges managed successfully with a multidisciplinary team.