Large multinodular goiters (MNG) with retrosternal extension present significant surgical challenges, particularly in resource-limited settings like Bangladesh. This case report describes the successful management of a huge MNG in a 39-year-old female using a trans-cervical approach, highlighting the importance of preoperative imaging, postoperative complications, and the healthcare challenges specific to developing countries. A 39-year-old female presented with a large anterior neck mass that had progressively enlarged over several years. Ultrasound and computed tomography (CT) confirmed the presence of a MNG with retrosternal extension. Fine needle aspiration (FNA) cytology revealed a benign follicular nodule. Preoperative biochemical findings showed subclinical hyperthyroidism and hypocalcemia. The patient underwent total thyroidectomy via a trans-cervical approach without the need for sternotomy. Postoperatively, the patient experienced transient hypocalcemia, which was managed with calcium and vitamin D supplementation, and mild transient hoarseness, likely due to recurrent laryngeal nerve (RLN) manipulation. The histopathological examination confirmed a benign MNG. The case demonstrates the feasibility and success of the trans-cervical approach in managing large retrosternal goiters, (RSG) minimizing postoperative morbidity while avoiding sternotomy. Preoperative imaging played a crucial role in surgical planning, and the management of transient complications was effective. This case also highlights the need for improved healthcare infrastructure and public health measures in regions like Bangladesh, where iodine deficiency remains prevalent
