Thyroidectomy is a typical procedure in planned schedule. The most common causes are benign and rarely malignant neoplasm, as well as unsuccessful treatment of hyperthyroidism which are leading to enlargement of the thyroid gland in the form of goiter A 82-year woman was delivered to local ER. Hospital refused to operate the patient because of the advanced state. There was a need to transport the patient to Clinique in bigger city. During the transport the patient received sedative medication in order to perform an intubation. The condition of the patient was stable. The surgery was performed as a emergency procedure. No complications occurred. Therapeutic plan: - Supplementation of thyroid hormones - Control of calcium and phosphate - Extubation - Pain killer treatment - Antibiotics Cloxacillin To sum up: Large thyroid goiter can lead to acute respiratory insufficiency which needs immediate surgical intervention.