Hypothyroidism is known to affect breathing by reducing respiratory drive. Near total narrowing of naso-oropharynx and larynx due to myxedema of upper airway in an undiagnosed severe hypothyroidism is a rare phenomenon. We report a case of non goitorous severe hypothyroidism presenting with upper airway obstruction in a 60 year old male-a diagnostic challenge in acute onset airway obstruction. An upper airway myxedema and hypertrophic myopathy of pharyngeal dilator muscles in hypothyroidism can present with severe acute airway compromise in absence of goitorous enlargement of the thyroid gland.