Perioperative management of an asymptomatic giant retrosternal goiter with high-risk imaging findings and an unanticipated cancer diagnosis: a case report.

Background: A retrosternal goiter (RSG) is defined as a thyroid mass with >50% of its volume extending into the mediastinum. Surgical resection is the definitive treatment. For patients with asymptomatic giant RSGs-a condition where watchful waiting is common yet carrying risks of compression and occult malignancy-the perioperative nursing literature lacks specific guidance. This creates a challenge in systematically addressing their dual needs: managing complex physiological risks (e.g., respiratory, neural) and providing psychological support for potential unexpected diagnoses. This case reports an asymptomatic patient with an incidental postoperative cancer. This report provides an indispensable reference for developing structured, evidence-based nursing protocols for this unique high-risk population. Case Description: A middle-aged female patient with a preoperatively asymptomatic yet radiologically high-risk RSG underwent a right-sided total thyroidectomy. Pathology unexpectedly revealed two foci of papillary thyroid microcarcinoma (PTMC). The nursing care adopted a dual-track strategy, addressing both the physiological risks (e.g., respiratory compromise, nerve injury) and the psychological distress associated with the incidental cancer diagnosis through proactive monitoring and structured communication. The patient recovered smoothly without complications, was discharged as planned, and maintained a stable psychological state throughout. Conclusions: For asymptomatic yet high-risk surgical patients, nursing must be proactive and evidence-driven rather than reactive. This case underscores the critical role of evidence-driven, anticipatory nursing that integrates physiological vigilance with psychological support in the holistic management of complex thyroid conditions, providing a valuable reference for similar clinical scenarios.