A 76-year-old woman, admitted with a 5-day history of fever and productive cough, had been experiencing progressive dyspnea on exertion, dysphagia, and frequent choking on food, for the past few years. Her vital signs were blood pressure, 148/66 mmHg; heart rate, 78 beats per minute; respiration rate, 20 breaths per minute; body temperature, 38.7°C. Physical examination revealed a large, soft, painless goiter in front of her neck (Fig. 1A). Chest X-ray revealed a neck mass with marked deviation of the trachea, and patchy opacities over the right lung field (Fig. 1B). Neck computed tomography revealed multiple heterogeneous enhancing nodules (up to 13.6 cm along the long axis) extending from the retropharyngeal region into the upper mediastinum, compressing and displacing the trachea, esophagus, and right internal jugular vein to the right (Fig. 2). Serum thyrotropin and free thyroxine levels were 0.15 μIU/mL (normal range, 0.25 to 5) and 0.84 ng/dL (normal range, 0.8 to 2), respectively. An intravenous piperacillin/tazobactam injection for aspiration pneumonia resolved her clinical symptoms. Fine-needle aspiration biopsy showed a benign follicular nodule. She is scheduled for total thyroidectomy.