Introduction: Retrosternal goiters requiring mediastinal access for thyroidectomy comprises less than one-third of thyroidectomies performed in major centers. This study aims to evaluate the outcomes of retrosternal goiters following thyroidectomies with mediastinal access. Methods: The study is a retrospective review of all patients with mediastinal retrosternal goiter who underwent surgery between 1st April 2011 and 1st March 2021 at a tertiary referral hospital. Demographic, clinicopathological data, radiological, and treatment outcomes data were analyzed. Results: A total of 13 patients underwent thyroidectomy with mediastinal access over a 10-year period from April 2011 to March 2021. Most of the goiters were in the posterior mediastinum, with eight out of 13 symptomatic at presentation, and the most common compressive symptom being that of dyspnea. Two-third of the resected retrosternal goiters were benign. The majority underwent a transcervical approach in combination with sternotomy, with two goiters in the mediastinum accessed by VATS. Whilst there were no mortalities, morbidities related to the complex surgery were mostly temporary hypocalcemia (30%) and laryngeal nerve injury (23%). Two patients presented with airway crises that required intervention with ECMO and tracheostomy. Discussion: Mediastinal goiters requiring surgery are uncommon and surgery can be challenging especially for those located in the posterior mediastinum. Complications of retrosternal goiter surgery are like that of standard thyroid surgery, however, the incidence of hypoparathyroidism and neuropraxia of the recurrent laryngeal nerve appears to be higher. Both ECMO and tracheostomy are strategies for difficult intubation.