Thyroid carcinoma may invade the upper mediastinum by direct extension of the primary or metastases to the paratracheal or retroclavicular-parajugular lymph nodes. From 1962 to 1994, 24 (16 papillary, 3 follicular, 3 medullary, and 2 undifferentiated) of 1204 thyroid cancer patients (2%) received trans-sternal cervico-mediastinal tumor resection. The tumor was resected totally in 16 patients, and residual at the time of initial operation in 8 patients. 9 patients were recived radiation therapy after surgery. The five-year survival was 64.7% and the 10-year survival was 46.7%. All of the patients who lived over 5 years had papillary carcinoma.