Objective. Intrathoracic goiters (ITGs) pose numerous challenges to head and neck surgeons due to the intricate relationships with major vessels and other mediastinal structures. Surgical excision remains the mainstay of treatment and we herein present an update on this topic. Methods. A systematic review from 2017 to date was performed in the PubMed database and a total of 93 articles were identified and discussed, along with methodological issues and future directions in the research on ITGs. Results. Transcervical excision is the commonest approach for treating ITGs, yet the potential need for a transthoracic approach must be always kept in mind. An acceptable rate of postoperative complications is expected if surgeries are carried out by experienced and dedicated surgical teams. Conclusions. Surgical excision remains the principal treatment for ITGs and new less invasive techniques are being developed. Surgery for ITGs should be always carried out in specialist centres with experienced multidisciplinary teams.
