ABSTRACT
The “Chikhaldara goiter”, a term coined to describe a massively enlarged multinodular thyroid gland, has caused the author and his team to develop a special surgical approach and management. The management starts with accurate assessment of structural and functional status of the gland. Although the incidence of malignancy in multinodular goiter is very small, the pathological assessment of suspicious nodules is the responsibility of the surgeon. They need to direct the pathologist to examine samples of the suspicious nodule. The surgery of unilateral multinodular goiter is reasonably uncontroversial, i.e., hemithyroidectomy. The authors have reasoned their own approach for bilateral disease for which total thyroidectomy is advised. Surgical pearls and post-operative management are discussed as complications seem to increase with the size of the goiter and in particular the retrosternality. However, the recurrent laryngeal nerve seems to be pushed out of harm's way quite in contrast to the parathyroid which are really at risk.
