Redo thyroid surgery is difficult for several reasons and may be complicated. In some cases airway management can be more difficult unexpectedly. In this situation, special airway devices may be required. Here we present a case of a 67-yearold female patient who suffer from recurrent substernal goiter and has dyspnea, cough, and fatigue. In this case, difficult intubation was managed with a gum elastic bougie that was placed into the classical laryngeal mask airway. Laryngeal mask airway was removed while gum elastic bougie was left in place to guide endotracheal tube insertion. The endotracheal tube was slipped over gum elastic bougie. In cases of difficult intubation, endotracheal intubation can be achieved with the guidance of gum elastic bougie placed through the laryngeal mask airway.