Substernal goiters are frequently associated with symptoms of local compression, including dyspnea, dysphagia and hoarseness. Rarely, an enlarged thyroid can cause venous compression of the mediastinal structures, compression of the thoracic duct is exceptional and may be manifested by chylothorax. We report a rare case of a 36-year-old woman with compression of the thoracic duct by a large goiter who presented with dyspnea. After undergoing chest drainage associated with a low-fat oral diet, the patient was treated with thyroidectomy. A trans-cervical thyroidectomy with ligation of the thoracic duct was performed without the need for a sternotomy. This led to resolution of her symptoms. Confirmation of resolution of chylothorax was obtained by postoperative CT scan. Chylothorax is a rare sequel to substernal goiter. It can be managed by thyroidectomy, the trans-cervical approach remains feasible. Sternotomy was avoided in this case

Keywords : Sub-Sternal Goiter- Chylothorax- Surgery