Acute upper airway obstruction may occur due to swelling of the thyroid gland. In such cases the onset of symptom is gradual as compared to fatal compression of neck and rarely causes sudden death. The authors report a case of death due to acute airway obstruction by complications of thyroid gland enlargement. The patients with a large goiter/ thyroid neck swelling, even asymptomatic, should be counseled about the impending complications by the treating doctor. The authors aim to add to Medical literature that acute airway obstruction due to natural causes may also be a cause of sudden death. Forensic Pathologists should consider this diagnosis in cases of sudden death with signs of asphyxia so as to prevent any misdiagnosis of violent asphyxial deaths.

Keywords: Acute Airway obstruction; Asphyxial deaths; Fatal thyroid enlargement; Adenomatous goiter.