A patient develops stridor shortly after extubation for thyroidectomy. What is the most likely diagnosis?

In the context of a patient who develops stridor shortly after extubation following a thyroidectomy, the most likely diagnosis is tracheomalacia. This condition occurs when there is weakness in the tracheal wall, leading to the collapse of the airway during breathing, particularly when the patient is extubated.

Perioperative manipulation of the thyroid gland can result in edema and trauma to surrounding structures, which may compromise the integrity of the trachea or contribute to increased instability in the airway. Following extubation, the airway is subject to dynamic changes, and the presence of stridor indicates a significant narrowing or obstruction due to the compromised tracheal support.

Hematoma may also cause airway compromise but would typically present with more acute respiratory distress and difficulty breathing as it can quickly create a mass effect and obstruct the airway. Similarly, while unilateral recurrent laryngeal nerve injury can lead to hoarseness and airway problems, stridor is more commonly associated with tracheal compromise. Tracheomalacia, specifically, results in stridor due to a loss of rigidity in the tracheal structure after the tube is removed when negative pressures are generated during inspiration.

Thus, the occurrence of stridor shortly after extubation in