We report the case of a 43-year-old woman with a giant retrosternal multinodular goiter causing progressive dyspnea and severe tracheal compression. Imaging revealed a mass extending from C5 to T9 vertebral levels. Given its extensive intrathoracic extension, a combined cervical incision and median sternotomy was performed. The mass was excised completely with preservation of the recurrent laryngeal nerves and parathyroid glands. The patient recovered uneventfully without complications. This case emphasizes the importance of multidisciplinary planning and highlights surgical decision-making in retrosternal goiters with mediastinal extension.