ABSTRACT
BACKGROUND: Combined open-heart surgery and thyroidectomy is a rare procedure. However, some difficulties will occur for cardiac surgery when thyromegaly extends into the retrosternal space.

CASE DETAILS: A 54-year-old woman suffering from dyspnea, chest pain and decreased left ventricular function (EF=40%) was diagnosed with coronary artery disease (3 vessel disease) and became candidate for coronary artery bypass grafting (CABG). Also, she had multinodular goiter with normal thyroid function test. After midsternotomy, a huge goiter was seen in the upper mediastinum.
Because the mass had covered the ascending aorta and involved the posterior aspect of the innominate vein making access to aorta impossible, thyroidectomy was performed at first followed by CABG. Post- operation course was satisfactory. Fourteen months later, the patient was euthyroid and in NYHA class1.

CONCLUSION: The evidence of the case showed that combined CABG and thyroidectomy can be performed safely.
KEYWORDS: Coronary Artery Bypass Grafting, Sub