A 48-year-old woman presented with a rapid enlargement of a pre-existing goiter without any compressive symptoms. She had a history of type 2 diabetes mellitus, hypertension, goiter, and primary hypothyroidism for fifteen years. The patient had no past or present history of smoking and an unremarkable family history.
The patient had complained of a productive cough for two weeks. However, there was no history of fever, night sweats, or anorexia. Examination Normal body temperature BMI: 35.88 kg/m 2 BP: 120/80 mmHg Pulse rate: 89 beats/min Respiration rate: 20 breaths/min Cervical examination: Plunging multinodular goiter without any lymphadenopathy Fasting blood glucose: 7.19 mmol/l Plasma creatinine level: 49 umol/l C-reactive protein: 5 mg/l Erythrocyte sedimentation rate: 57 mm/first hour RBC count: 4.38 ∗ 106/mm 3 Total hemoglobin concentration: 12.8 g/dl WBC count: 6800/mm 3…
