Most cervico-mediastinal goiters are situated in the anterior mediastinal compartment, but according to the literature, 10–15 percent of them are located in the posterior mediastinum. Although most anterior mediastinal goiters can be removed by using the transcervical approach, cervico-mediastinal goiters in the posterior mediastinal may require additional extracervical incisions. We report the case of a huge cervico-mediastinal goiter extending from the neck retrotracheally to the posterior mediastinum. Surgical removal is the treatment of choice in such cases. We performed an operation using a transcervical and right posterolateral thoracotomy approach. Histopathological examination confirmed the diagnosis of a large toxic goiter. The patient recovered well and was discharged in one week. While most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch are better dealt with by either sternotomy or thoracotomy. This report describes the use of transcervical and posterolateral thoracotomy with an excellent postoperative result.