Retrosternal goiter (RSG) occurs in 2-26% of thyroidectomies. We do not know why some goitres grow "outwards", and others grow "inwards". The features of RSG will be discussed, including the assessment and indications for surgery. Most RSGs can be removed trans-cervically. A novel shaver debulking technique is often effective, so sternotomy or thoracotomy is rarely required.