Intrathoracic giant goitre is often defined as an enlarged thyroid gland with more than 50% of its volume below the thoracic inlet. Selecting a surgical approach based on the location, shape, and size is commonly described in the literature.

A patient with a history of end-stage renal disease, without any obstructive symptoms, and CT signs of tubular-shaped and subcarinal-extended retro tracheal intrathoracic goitre was admitted to our hospital. As there is no agreed standard, we decided to use a transcervical approach based on the shape and comparing intrathoracic thyroid goitre and thoracic inlet diameters.

The transcervical approach with blunt dissection and mild traction was feasible in our case. There was no major bleeding or signs of recurrent laryngeal nerve injury or hypocalcaemia. Serum calcium level was 2,25mmol/L on the third postoperative day. The patient was discharged on 3rd postoperative day. Postoperative histology analysis confirmed benign multinodular goitre.

Preoperative assessment using CT and comparing the shape and dimension of intrathoracic thyroid goitre is benefcial in choosing between a transcervical or an extracervical approach.