Abstract
Retrosternal goitre is not an uncommon entity owing to various reasons - ignorance, fear, lack of access to safe surgical technique, incomplete thyroid surgery. Retrosternal goitre could have varied presentations, especially in cases with prior thyroid surgery. Fifty-three-year-old female with history of thyroid surgery 20 years back presented with a large neglected anterior neck swelling. Computed tomography imaging revealed the rare entity of an isolated mediastinal goitre type 3 with no communication with the cervical thyroid gland. Careful evaluation of computed tomography and pathology indicated the need for extra - cervical approach. Patient underwent total thyroidectomy and mediastinal goitre excision via cervical and median sternotomy approach. Post operative histopathology revealed benign adenomatous goitre. CT imaging of retrosternal goitre is of primary importance along with appropriate CT grading. Mediastinal seeding of thyroid goitre could occur in cases with prior thyroid surgery. Extra cervical approaches for primary mediastinal goitre are recommended. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-024-04663-2.