Primary intrathoracic goiters arising from aberrant thyroid tissue are rare, representing <1% of all retrosternal goiters (RGs). We report a rare case of primary RG in a male patient with symptoms of mediastinal mass lesion alone. By careful examination and with the help of radiological imaging, we could pick up a thyroid swelling with a mediastinal mass which led to a diagnostic dilemma, as the thyroid swelling was reported as a multinodular goiter and the mediastinal mass was misdiagnosed as teratoma. We subjected the patient to a functional imaging with a thyroid scintigraphy, which revealed a thyroid swelling with retrosternal extension that was managed by surgery (total thyroidectomy and mediastinal mass excision) with only a Kocher's neck crease incision.
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