<p class="abstract">Primary thyroid lymphoma and laryngeal lymphoma are rare malignancies of the head and neck region. Airway obstruction caused by primary thyroid lymphoma is mainly by means of direct compression of trachea by huge thyroid mass. We present the first case report of diffuse large B cell lymphoma of thyroid gland with extension to pyriform fossa, in the absence of preexisting chronic thyroiditis. In this case, emergency airway obstruction was caused by direct extension of disease into pyriform fossa, occluding laryngeal inlet. We reviewed English literature between 1981 and 2018 for cases of primary thyroid lymphoma. There are no reported cases of primary thyroid lymphoma with direct extension into pyriform fossa. This presentation posed a great challenge in securing a patent airway by means of oral intubation and tracheostomy.</p><p class="abstract"> </p>