Thyroid tumors arising in the mediastinum are defined as intrathoracic goiters (the terms "retrosternal" and "intrathoracic" are used interchangeably in the literature) when the mediastinal portion is larger than the cervical portion and extends beyond the thoracic inlet by two fingerbreadths or at least 4 four cm. Patients with symptomatic retrosternal goiters are typically recommended for surgical intervention, while the treatment strategy for patients with asymptomatic retrosternal goiters remains unclear. This article describes a clinical case of preoperative risk assessment, surgical technique, and prevention of postoperative complications in a patient with a left-sided nodular goiter complicated by tracheal compression and a retrosternal location. Considering the fact that in most cases of substernal goiter the results of puncture biopsy are benign, the advisability of surgical intervention in asymptomatic patients is questionable.