Clinical presentation: a 76-year-old man with hoarseness. The goiter was known for decades and grown slowly. Laryngology revealed palsy of the left nervus recurrens.

Palpation: both lobes of the thyroid were highly enlarged and nodular.

Functional state: euthyroidism with normal FT4 (14.9 pM/L) and FT3 (3.06 pM/L) level and subnormal TSH (0.15 mIU/L).

Ultrasonography: a multinodular goiter with both retrotracheal and substernal spread.

Cytological report: a benign, colloid goiter.

Suggestion: neck and chest CT examination before surgery in order to determine the extent of the substernal spread.

Histopathology: a benign, nodular goiter.