Recently, we successfully removed a “huge retrosternal goiter” for a year-old, frail, sickly, and seriously ill patient without splitting the sternum, which greatly reduced the trauma to the patient and resulted in a smooth recovery. The procedure is described below. Huang Gang, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Guangzhou Medical University Patient Wu Moudi, female, 72 years old. She was admitted to the hospital on November 9, 2015 due to “neck mass for more than 30 years, intermittent shortness of breath for more than 4 years, aggravation and severe shortness of breath for more than 1 month”. The patient had bilateral neck masses, about the size of a small pigeon’s egg, which were found more than 30 years ago and were not treated. As she grew older, the masses gradually increased in size. About 4 years ago, he started to have asthma, which was obvious after lying down at night and could be relieved by treatment at the local hospital, but it worsened year by year. 1 month ago, the asthma worsened significantly, and the asthma was severe at night when lying down, which affected breathing. After physical examination, the doctor considered that the asthma was caused by bilateral enlargement of the thyroid gland and its growth down to the posterior sternum, compressing the airways. The CT of the neck and chest showed: “The thyroid glands of the right and left lobes were significantly enlarged and extended downward to the level of the ramus and posterior to the trachea, with inhomogeneous density, dotted high-density and low-density shadows, and compression of the esophagus causing its partial rightward shift. Multiple small nodules in the posterior segment of the right upper lung, which resembled granulomas. Scattered inflammation in the subpleural and two lower lungs of the posterior segment of both upper lungs, and multiple enlarged mediastinal lymph nodes. Diagnosis: giant retrosternal nodular goiter (bilateral), tracheal stenosis with asthma (due to compression), etc. Due to the patient’s age, serious and complicated condition, and having suffered from “diabetes mellitus” for more than 20 years and taking medication for a long time, he was weak. On November 13, 2015, after a thorough examination and adequate preoperative preparation, the patient underwent “retrosternal giant thyroidectomy” under general anesthesia, and intraoperatively, he saw that the left and right lobes of the thyroid gland were obviously enlarged, and the left lobe of the thyroid gland was about 15 cm X 5 cm X 4 cm, and the right lobe was about 12 cm X 4 cm X 4 cm. The two lobes protruded downward to more than 10 cm behind the sternum and reached the bifurcation of the trachea, and wrapped around and compressed the trachea and esophagus backward. After precise dissection and separation, the huge retrosternal goiter was successfully removed without splitting the sternum, which greatly reduced the trauma to the patient. The patient’s vital signs were stable. The patient’s vital signs were stable. The patient’s postoperative recovery was smooth.