barw Judi Clinical Journal 3105-4102 2 1 2026 06 20 Anaplastic Thyroid Carcinoma and Toxic Multinodular Goiter: A Case Report and Literature Review 49 53 10.70955/JCJ.2026.07 eng Abdulwahid M. Salih Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq 0009-0006-5546-5878 Rebaz M. Ali Department of Oncology, Hiwa Cancer Hospital, Shorsh Street, Sulaymaniyah, Kurdistan, Iraq Rawa M. Ali Department of Pathology, Hospital for the Treatment of Chemical Weapons Victims, Mawlawi Street, Halabja, Kurdistan, Iraq Ahmed H. Ahmed Department of Radiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq Shko H. Hassan Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq Hawkar A. Nasralla Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq Shalaw A. Nasraldeen Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq Abdullah A. Qadir Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq Harun Amanj Ahmed Department of Head & Neck Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq 2026 05 11 Introduction: Anaplastic thyroid carcinoma (ATC) is a rare thyroid malignancy, comprising approximately 2% of all thyroid cancers, yet accounting for the majority of thyroid cancer-related deaths. ATC is characterized by aggressive behavior and rapid local invasion, leading to life-threatening complications such as airway compromise, dysphagia, and vascular encasement. Longstanding thyroid conditions such as multinodular goiter (MNG) may predispose to malignant transformation into ATC. We report a case of ATC arising in a patient with a decade-long history of toxic MNG, underscoring the potential for severe complications even in seemingly stable thyroid disease. Case presentation: A 68-year-old female with a 10-year history of toxic MNG presented with neck swelling, dyspnea, and dysphagia. Laboratory findings showed suppressed thyroid-stimulating hormone and elevated free T4. Ultrasonography revealed nodules with macrocalcifications. A total thyroidectomy was performed, and histopathological examination revealed ATC originating from one of the MNG nodules. Postoperatively, she received adjuvant chemoradiotherapy with carboplatin and doxorubicin.  Initial imaging showed no metastasis, but after 10 months, a supraclavicular lymph node and posterior lung nodules indicated disease progression. She developed pneumonia during treatment, leading to its discontinuation. Despite restarting therapy, her condition worsened, and she passed away eight months later. Literature review: A literature review identified six reported cases of ATC arising from MNG published between 2001 and 2020. The duration of MNG before malignant transformation varied from years to decades. Conclusion: Longstanding MNG may progress to malignancy over time. Early diagnosis and appropriate management of MNGs are critical to minimizing the risk of malignant transformation.