# Retrosternal Goitre

URL: https://thethyroidologist.com/conditions/retrosternal-goitre/
Section: Conditions
Last medically reviewed: 2025-11-15

> A retrosternal goitre extends below the breastbone and can press on the windpipe. Symptoms, assessment and treatment options.

A retrosternal goitre is an enlarged thyroid that grows downwards below the breastbone into the upper chest. Because the space there is tight, it can press on the windpipe, swallowing passage or blood vessels.
Many people have no symptoms, but a large retrosternal goitre can cause breathing or swallowing difficulty and usually needs specialist assessment.

## How it develops

Most retrosternal goitres begin as a neck goitre and gradually extend downwards through the thoracic inlet. The blood supply usually still comes from the neck, which is important for surgical planning.
They are often multinodular and may be associated with normal, low or high thyroid function.

## Symptoms

Small retrosternal goitres may cause no symptoms. Larger ones can cause breathlessness — especially lying flat or on exertion — a persistent cough, difficulty swallowing, or a feeling of pressure in the chest.
A sudden change in size, such as bleeding into a nodule, can cause rapid compression and is an emergency.

## Assessment

Assessment includes examination, thyroid function tests and imaging. Ultrasound shows the neck component, while CT or MRI defines how far the goitre extends and whether it narrows the windpipe.
Flow-volume testing of breathing may be used when compression is suspected.

## Treatment

Surgery is the main treatment for symptomatic or significantly compressive retrosternal goitre, and most can be removed through a neck incision. A small proportion require a chest approach with cardiothoracic support.
Radioactive iodine can shrink some goitres but may cause temporary swelling, so it is used cautiously when compression is present. Observation may suit small, asymptomatic goitres.

## Frequently asked questions

### Is a retrosternal goitre cancer?

Most are benign multinodular goitres. Cancer can occur within them, so assessment and sometimes biopsy are needed.

### Does it always need surgery?

No — small, asymptomatic goitres may be monitored. Surgery is considered when there are symptoms, significant compression or suspicion of cancer.

### Can it be removed through the neck?

Most retrosternal goitres can be removed through a neck incision. A minority extending deep into the chest need a combined approach.

### What imaging will I need?

Ultrasound is standard, and CT is often used to define the extent and any windpipe compression.

## Disclaimer

The content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your specific condition.

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