Clinical data: A 38-year-old woman came to a routine follow-up. I met her 15 month ago during the 12th week of her pregnancy. At that time a large multinodular goiter was diagnosed which caused no complaints. Cytology resulted in benign colloid goiter. A repeat ultrasound was performed at the 21st week of pregnancy when no significant change was observed. I suggested surgery after finishing of lactation. In the present study, the patient had already reported intermittent swallowing complaints.

Palpation: Both lobes and the isthmus were enlarged and nodular on palpation.

Laboratory tests: TSH 0.49 mIU/L, FT4 12.8 pM/L.

Ultrasonography. The thyroid was composed of multiple nodules with different echogenicities. The lower pole of the right lobe could not be visualized in a supine position with the neck held back while it became visible during swallowing.

Total thyroidectomy was performed.  Histopathology disclosed benign hyperplastic nodules.

Comment. If the lower pole of an enlarged lobe becomes clearly visible during swallowing, then it can be safely said that the thyroid gland can be removed by neck excision. If we have any doubt, a neck and upper mediastinal CT scan is mandatory.