Surgery?

I am a 47 year old woman diagnosed several years ago with Hashimoto's. I also have a goiter with multiple nodules. This fall my GP suggested I see a surgeon to see if the goiter was large enough to indicate surgery. The surgeon said she thought that (by feel) it might not be necessary yet, but ordered an MRI for further evaluation. (The numbers from several ultrasounds vary so much, even she said it's hard to get a sense of the actual size.) I have the MRI results, but I'm having a lot of difficulty contacting her for a follow up, as her office hours are limited. The report says:

Massive enlargement of the left lobe and isthmus. Enlargement is nodular w/some calcification. It extends into the mediastinum. Substernal component in the mediastinum is cystic and nodular. In the thyroid bed, the mass is 46.5mm x 48.9mm. In the superior mediastinum, it's 56.6mm x 42.6mm. A portion extends to the level of the hyoid bone. Mass significantly displaces larynx and trachea to the right. Trachea is minimally compressed in the neck, but significantly in the superior mediastinum: intrathoracic trachea is rather oblong and max width at max compression is 9mm. Large mediastinal component terminates slightly superior to the carina. Significant lateral displacement of the carotid space on the left. Various arteries are displaced and splayed, as is the jugular. Larynx is displaced, but intrinsically normal.

Questions: Do doctors use "massive" as lay people do? Is this a large/very large goiter or not? What's the normal width of the trachea? I told my GP a few years ago that I sometimes get out of breath climbing stairs/feel as though I can't get enough air in my lungs. He said it was asthma, but did no testing. Could it really be the thyroid pressing on the trachea? I don't have problems actually swallowing, but I definitely get that "something pressing on my throat" feeling more often lately. Do these results suggest to you that it's time for surgery?

[Mark Lupo, M.D.]

based on the mri reading this is a very large goiter that is causing compression of the windpipe and it is extending into the upper chest.  it may be time to consider removing it.  the nodularity is mostly all inflammation due to hashimotos but removing or doing biopsies would be necessary to help address the 5 to 10% chance there is a cancer within the goiter.