Intrathoracic goitres (ITGs) are extensions of multinodular goitres (MNGs) beyond the thoracic inlet, presenting challenges in classification and management. Various definitions exist, leading to inconsistencies in identifying the need for surgery. Symptomatic ITGs, marked by dyspnea or compression, demand surgical intervention due to potential growth and malignancy risks. Preoperative evaluation involves imaging, thyroid function tests, and biopsy. Multiplanar CT scans guide the choice of surgical approach, with a transcervical route preferred for most cases. However, certain shapes or extensions beyond the aortic arch might necessitate sternotomy or alternative minimally invasive techniques.

This case report details a 27-year-old female with an ectopic intrathoracic goitre, presenting with chest discomfort and breathing difficulties. Surgical excision involved total thyroidectomy and removal of the intrathoracic component through cervical incision and bilateral video-assisted thoracoscopic surgery (VATS). Postoperative complications included transient hypocalcemia, managed with calcium and vitamin supplements.

The patient recovered well postoperatively, with normalization of calcium levels over two years. Histopathological examination revealed nodular hyperplasia in the thyroid tissue. The surgical strategy, outlined based on literature review, highlighted the significance of accurate preoperative imaging in determining the appropriate surgical approach for ITGs.

Management of ITGs requires careful preoperative evaluation using CT scans to determine the most suitable surgical strategy. While most cases can be managed via a transcervical approach, specific shapes and extensions might warrant sternotomy or alternative minimally invasive techniques. Experienced surgical teams facilitate successful outcomes in ITG excision, emphasizing the importance of thorough planning and execution.