Primary thyroid lymphoma (PTL) is a rare malignancy that originates in the thyroid gland. It can appear as a fast-growing mass in the mediastinum, which can may compress the trachea, and cause respiratory difficulties. Because it is a rare condition, diagnosing it can be a challenge and this can impact the treatment options available. The type of surgery required depends on the location, depth, and extent of the invasion. If the tumour has penetrated the tracheal mucosa, then complete removal is necessary but, this can lead to serious complications We report a unique manifestation of the PTL involving the trachea and complicated by severe airway obstruction and perforation.