# When Poverty Delays Care: The Silent Burden of Neglected Goiters in a World Where Basic Surgery Becomes a Luxury

## TL;DR

A woman in a remote Moroccan village developed a massive thyroid goiter due to lack of access to medical care, highlighting the global issue of delayed surgical treatment in low-resource areas.

## Contribution

This case highlights the consequences of delayed surgical care in low-resource settings and emphasizes the need for improved access to essential surgical services.

## Key findings

- A 62-year-old woman presented with a 25-year history of an untreated goiter resulting in severe tracheal compression.
- Awake fiberoptic intubation and total thyroidectomy successfully treated the giant multinodular goiter.
- The case underscores the impact of poverty and geographic isolation on access to essential surgical care.

## Abstract

Neglected thyroid disease remains a preventable cause of morbidity in low-resource regions, where poverty, limited surgical capacity, and geographical isolation delay access to essential care. In settings with reduced healthcare infrastructure, benign goiters may progress over decades, ultimately reaching massive sizes capable of compressing vital cervical structures. We report the case of a 62-year-old woman from an isolated mountainous hamlet in the High Zaïan foothills of Morocco who developed a giant anterior neck mass that had progressively enlarged for 25 years due to a complete lack of access to medical and surgical services. She presented with severe tracheal compression, dysphagia, and exertional dyspnea. Contrast-enhanced computed tomography revealed a giant multinodular goiter with marked rightward airway deviation and retrosternal extension. Because of the anticipated difficult airway, awake fiberoptic intubation under local anesthesia was performed, followed by total thyroidectomy, yielding a 1.8-kg multinodular specimen. The postoperative course was uneventful, and histopathology confirmed benign multinodular hyperplasia. This case illustrates how socioeconomic vulnerability and geographic isolation can transform a curable condition into a life-threatening deformity, underscoring the urgent global need to improve access to essential surgical care.