The retrospective analysis of a series of 350 cases of intrathoracic goiters, out of a total of 5,000 thyroid operations derived from the joined case records of the 3rd General Surgery Institute (Director: Prof. G. Di Matteo) and the 8th Chair of Surgical Pathology (Director: Prof. F.P. Campana), has induced the authors to reconsider the surgical approach to this pathology on the basis of anatomo-surgical factors.