Thyroid nodules with cystic component are common and the vast majority of them do not cause symptoms. Their neck location, close to airway and vascular structures, makes them a potentially life-threating condition if they become bigger or suffer from an acute haemorrhage. In this case report we expose the case of a twenty-two year old man who went to our emergency service suffering from odynophagia and neck swelling. He was diagnosed with giant thyroid cyst and critical tracheal compression. Initially, in order to relieve symptoms, we carried out two ultrasound-guided aspirations; later, as final treatment, the patient underwent thyroid lobectomy. He progressed successfully without postoperative complications. In our experience, surgery is an effective and definitive treatment to consider in cases for big thyroid cyst in young patients.