There are three types of retrosternal goiters (RGs): 1) primary intra-thoracic goiters that arise from aberrant thyroid tissue in the mediastinum, 2) secondary RGs that develop from downward migration of the thyroid gland into the mediastinum, and 3) plunging goiters that rise and fall through the thoracic inlet. Secondary RGs are most common and are connected to the cervical thyroid, receiving blood supply from cervical vessels. Symptoms include dyspnea that is worsened by positions reducing the thoracic inlet, and sometimes dysphagia. Thyroidectomy is the treatment, performed via cervical approach but sometimes requiring median sternotomy.