A64-year-old man presented with a gradually enlarging right-

sided neck mass over two years, recently associated with

dysphagia and exertional dyspnea. Clinical examination

revealed a firm right-lobe goiter extending to the suprasternal

notch and causing tracheal deviation to the left. There was no

cervical lymphadenopathy. Thyroid function tests were

normal.

Because of progressive airway compression, surgical

exploration was undertaken. Intraoperatively, a firm, highly

vascular tumor of the right lobe was found extending

retrosternally and into the IJV via the middle thyroid vein. A

total thyroidectomy with en bloc resection of the middle

thyroid vein and a cuff of the invaded IJV was performed. The

IJV continuity was restored using a patch graft from the right

external jugular vein. The patient recovered uneventfully