Retrosternal Goitre
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.
Last medically reviewed: 15 November 2025
Key points
- A retrosternal goitre extends from the neck into the upper chest.
- It can compress the windpipe, causing breathlessness, cough or stridor.
- CT imaging is often used to assess its extent and effect on nearby structures.
- Surgery is the usual treatment when symptoms or significant compression are present.
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.
When to seek urgent medical help
- Stridor, severe breathlessness or difficulty breathing when lying flat.
- Rapidly enlarging neck or chest swelling.
- Difficulty swallowing with weight loss or coughing blood.
This guidance does not replace emergency services. If you are seriously unwell, seek urgent medical care immediately.
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.
References & further reading
This page is based on established medical knowledge and guidelines from authoritative sources. Always consult a qualified clinician for personal medical advice.
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