Cancers of the thyroid gland are uncommon, accounting for 1% of malignant tumors. Oncocytic carcinoma of the thyroid (OCA), previously known as "Hürthle cell" carcinomas, make up 3% to 5% of all thyroid cancers and are extremely rare. In the United States, the incidence of thyroid cancer is approximately 12 per 100,000 per year and increases with age. The prevalence of thyroid cancers in women is estimated to be twice that in men, with the male gender correlating with a worse prognosis.A definitive diagnosis of OCA is confirmed after complete excision and histopathological examination. OCA is an aggressive tumor with an exceedingly low incidence, a high risk of metastasis, and a poor prognosis. The mainstay of therapy for OCA is surgery. In order to recognize and treat the disease as early as possible, healthcare providers must consider the probability of OCA in patients presenting with a thyroid mass.We hereby present a case of OCA identified incidentally status post tracheostomy and subsequent biopsy. We have an opportunity to review this disease with the hope of improving outcomes by raising awareness and with early recognition.