Aim: Approach to a patient like a primary physician with meticulousness in eliciting history and evaluation, makes an anaesthesiolgist a perioperative physician. Case Report: Our patient was diagnosed to have bronchial asthma for 3 years duration and admitted with a renal malignancy. During pre operative evaluation he was found to have mediastinal widening. On further evaluation with computerized tomography, diagnosed to have retrosternal goitre compressing the trachea. Combined procedure of right nephrectomy and right hemithyroidectomy was done necessitating sternotomy. On post-operative follow up patient had no wheeze after the thyroidectomy. Discussion: The natural history of retrosternal goitre is of a slow increase in size, often presenting as an incidental finding on a chest x-ray. Patients with retrosternal/substernal goiter may not have an obvious swelling in the neck. They may present with wheeze and wrongly labelled as an asthmatic like in our patient. Late onset wheeze, persistent wheeze inspite of treatment, exertional dyspnoea, widening of superior mediastinum in chest x-ray made us to think about possible airway obstruction other than bronchial asthma for wheeze. Confirmed it to be a paratracheal, retrosternal colloid goitre. Conclusion: The late onset wheezer to be evaluated for anatomical airway obstructions. Approach to a patient like a primary physician with meticulousness in eliciting history and evaluation, makes an anaesthesiolgist a perioperative physician.