Thirty-six-year-old man was presented with a new onset swelling in the upper neck of 1 year duration. There were no pressure symptoms or voice change. No history suggestive of hypo/hyperthyroidism. On examination, there was a 6 × 4 cm cystic swelling in the infrahyoid region, which moved with deglutition and protrusion of tongue. The swelling had restricted mobility in the vertical plane. The thyroid gland was not palpable and there were no palpable cervical nodes. Computed tomography of neck and thorax was done in view of the locally advanced nature of the swelling—images attached. He then underwent total thyroidectomy + Sistrunk's operation.