The patient came to the clinic 13-April-2002 complaining of LBP with left sciatica for 7 months. MRI performed 16-April-2002 showed huge extruded disc L4-5 and surgery was advised and disappeared.

The patient then came 19-July-2010 complaining of exacerbation of the LBP with agonizing left sciatica.

On examination: the patient had exaggerated scoliotic stance, limping, weak dorsiflexion and planterflexion left foot 4/5. The patient also had enlarged thyroid.

MRI lumbar spine performed 20-July-2010 showing the same extrusion central more to the left. Thyroid functions showed high TSH with multinodular goiter.

Partial flavotomy of the L4-5 left side with foraminotomy left L5 root. The extruded disc was removed in several pieces and meticulous cleaning of the disc space was achieved from the left side.

Smooth postoperative recovery and improvement of the power of left foot.

This case demonstrate that the patient can tolerate huge disc for long time, but stress due to continuous pain caused thyroid malfunction.

Some times it happens that the disc extrusion resolve over the time, but this phenomenon happens with in 3-4 months and the patient recover completely.

In this case, this could was the case and de novo extrusion took place at the same level. Her distressing pain enforced her to the surgical option.