OBJECTIVE: A case of acute wheezing causing primitive thyroid lymphoma observed ay the Operative Unit of General and Thoracic Surgery of the University “P. Giaccone” of Palermo, Italy, is reported. EXPERIMENTAL DESIGN: Diagnostic, clinical and prognostic indication, evaluation of effectveness of radical surgical treatment and follow-up. INTERVENTION: Emergency radical surgical treatment (debulking) and surgical tracheostomy (tracheal infiltration) RESULTS: Complete recovery with “restitutio ad integrum”. No relapse were recorded ad short follow-up. CONCLUSIONS: Total thyroidectomy in front of uncertain cytology with the suspect of Hashimoto’ s treatment or acute wheezing or localized neoplasm (IE or IIE) is feasible and rationale. If possible, this treatment of choice must observe standard technique, with visualization and respect of four parathyroid glands and recurrent laryngeal nerves. This intervention has good prognosis and low morbidity and mortality in well experiences surgical teams of thyroid surgery.