The majority of substernal goiters can be retrieved through the neck. However, sternotomy is indicated in roughly 1% to 8% of cases. Herein, we report a case of huge anterior mediastinal goiter removed via median sternotomy. A 62-year-old woman visited our hospital in October 2015, complaining of a large mass in her neck. Her thyroid function test results including antibody levels were within normal limits. Ultrasonography showed multiple nodules that ranged in diameter from 1.0 to 4.7 cm. We were unable to exclude the possibility of papillary thyroid carcinoma following fine-needle aspiration cytology. Furthermore, computed tomography revealed a bulky, 17×8×6 cm thyroid gland that extended to the thoracic cavity. The patient underwent total thyroidectomy via median sternotomy in December 2016; the operation time was 370 minutes. During surgery, 600 mL of red blood cells were transfused, and the patient's estimated blood loss was 1,600 mL. The patient's Simplified Acute Physiology Score III was 35, and she was admitted to the intensive care unit for 2 days immediately post-operation. The recovered patient was discharged 11 days after the operation. The pathologist reported multi-nodular hyperplasia, along with stage I (T1aN0) papillary thyroid microcarcinoma. Sternal split occurs in cases involving difficult retrieval of substernal components or unexpected thoracic hemorrhage. Patients should be well informed of sternotomy and its potential complications.