Most intrathoracic goiters are in the anterior compartment of the mediastinum. Superior vena cava (SVC) syndrome and tracheal compression existing together is a rare presentation of thyroid disease. The authors present a patient with SVC syndrome and tracheal compression because of an intrathoracic multinodular goiter. A median sternotomy and a standard cervical collar incision were required to treat the patient. After surgery, all symptoms of SVC syndrome and tracheal compression subsided.