Most mediastinal goiters are extensions of cervical goiters. Patients are generally female and only occasionally have symptoms. Patients most commonly complain of a mass-like sensation, dyspnoea, dysphagia and cough. The authors describe the case of a 67 year-old female who presented at the emergency room with dyspnoea, anterior cervical discomfort and tightness which had onset a few months prior but which had worsened in the last week. The patient cited a history of bronchial asthma, for which she was under medication, but the true diagnosis was mediastinal goiter.