The Authors report their experience in the management of substernal goitres as classified by Dor, Carcassonne, Merlier and Eschapasse. Through a literature review an accurate identification of both symptomatologic features and diagnostic protocol is stressed. Surgical procedure is represented in the majority of cases by a nearly total thyroidectomy through a cervical approach. A median total sternotomy is the approach needed to assure the best exposure in case of retrovascular goitre.