The Authors, on the basis of their experience, as well as of the data of the literature, discuss the problems of technique and tactics involved in the treatment of retrosternal goiters. As to the way of approach, they think cervicotomy should be primarily preferred, and the complementary sternotomy should be associated to the former only in some limited cases of totally dipped and large-sized goiter. They, moreover, assert that, beyond the diagnostical and therapeutical difficulties, endothoracic goiter, if adequately treated, keeps a favourable diagnosis, not dissimilar from the one of cervical goiters.