A 75-year-old woman with thyrotoxicosis was referred for radio-iodine therapy. A thyroid Tc-99m pertechnetate scan revealed bilateral increased uptake with an unusual pattern of retrosternal extension. Computed tomography was performed which showed a goiter extending anterior to the right atrium finely connected to the cervical component. The patient denied any compressive symptoms and received radioiodine therapy. Despite extending deep into the mediastinum, retrosternal goiters can be asymptomatic as demonstrated in this case.
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