Surgical management of a large retrosternal goiter: a case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Retrosternal goiters are usually managed through a cervical approach; however, mediastinal extension and close proximity to major vessels may necessitate a sternotomy for safe resection. Careful preoperative evaluation and individualized surgical planning are essential in such complex cases. CASE PRESENTATION: We report a 45-year-old woman with a longstanding multinodular goiter, presenting with progressive compressive symptoms. Computed tomography revealed a large retrosternal goiter with mediastinal extension and mass effect on adjacent structures. The patient underwent total thyroidectomy through a combined cervical approach and median sternotomy. Complete resection was achieved without vascular or recurrent laryngeal nerve injury. CLINICAL DISCUSSION: Large retrosternal goiters with mediastinal extension present significant operative challenges because of their close relationship to major mediastinal structures. Careful preoperative assessment and multidisciplinary coordination are essential for selecting the appropriate surgical approach and achieving safe resection. Meticulous extracapsular dissection and adequate surgical exposure help minimize vascular and neural complications. CONCLUSION: Complex retrosternal goiters with mediastinal vascular involvement may require sternotomy to achieve complete and safe excision. This case emphasizes the value of individualized operative planning and multidisciplinary management in optimizing surgical outcomes.