Introduction: Compressive goiter is a rare but life-threatening ENT emergency. Its presentation as acute dyspnea indicates advanced tracheal compression, requiring rapid and multidisciplinary diagnostic and therapeutic management. Patients and Methods: This was a retrospective descriptive study conducted over a 5-year period, including 5 patients managed for acute dyspnea revealing a large compressive goiter. Epidemiological, clinical, paraclinical, therapeutic, and outcome data were analyzed. Results: The mean age of the patients was 65 years, with a clear female predominance (80%). All had multinodular goiters evolving for over 20 years. Acute dyspnea was the constant reason for admission, classified as stage 3–4 on the ATS dyspnea scale. Cervico-thoracic computed tomography (CT) was the key examination, demonstrating severe tracheal compression with >70% reduction in lumen in all cases, and retrothyroidism in 3 cases. Emergency total thyroidectomy was performed in all patients, resulting in immediate tracheal release. Postoperative outcomes were uneventful in 4 cases; one case presented with transient hypocalcemia. Histopathological examination concluded benign goiter in all cases. Conclusion: Compressive goiter is a serious complication of neglected goiters. Its revelation by acute dyspnea constitutes a life-threatening emergency. Cervico-thoracic CT is the gold standard for assessing compression and guiding surgical strategy. Emergency total thyroidectomy remains the treatment of choice, ensuring effective and definitive decompression, with excellent outcomes when performed by an experienced team.
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