Background: Retrosternal goiters (RGs) pose several challenges to head and neck surgeons because of the intricate anatomical relationships with major vessels and other mediastinal structures. Methods: A scoping review of the last five years in the PubMed database was conducted and a total of 105 articles were discussed, along with methodological issues and future directions in the research on RGs. Results: The surgical excision of RGs may be accomplished by standard transcervical approach in the vast majority of cases, yet the potential need for a transthoracic approach must be always kept in mind. Great expertise in referral centers is required to maintain an acceptable rate of postoperative complications, and a thorough diagnostic work-up is mandatory. Several non-surgical treatments in addition to mini-invasive approaches have been proposed for RGs. Conclusions: RGs require a multidisciplinary thyroid team in order to eventually minimize the risk of complications and avoid extracervical approaches.