Retrosternal Goitre with Retrotracheal Extension

Although retrosternal extension of goitre is reported in approximately 5-20% of patients with thyroid enlargement, true retrotracheal extension is extremely rare and seldom reported. Awareness of this configuration is essential for preoperative planning and safe surgical management. We describe a 52-year-old woman with recurrent multinodular goitre showing posterior extension behind the trachea, causing airway displacement and compression of adjacent vascular structures. Although benign, such extensive retrotracheal goitres may simulate invasive thyroid carcinoma clinically and radiologically, necessitating comparable preoperative evaluation and surgical precision. The lesion was well delineated on cross-sectional imaging and was completely excised through a transcervical approach without sternotomy. This case underscores the importance of detailed imaging and multidisciplinary coordination in achieving safe resection of thyroid enlargements with atypical posterior extensions.