A 68-year-old woman with a long-standing history of an enlarging multinodular goiter that was refractory to medical suppression presented with increasing dysphagia. Radiologic evaluation revealed a substernal component (Figure 1). The patient successfully underwent a total thyroidectomy. Pathologic analysis revealed 2 foci of well-contained papillary thyroid carcinoma involving the right lobe, with no tumor evident within the left lobe. Postoperatively, the patient has done well and has no dysphonia or dysphagia.