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Surgical emphysema secondary to tracheal tear is a rare but serious complication after thyroidectomy. It is usually resolved by conservative management; but in case of compromised airway, early airway control and surgical intervention is required. This is the case report of a 52-year woman diagnosed as thyroid carcinoma, who developed rapidly progressive surgical emphysema involving head and upper thorax, following total thyroidectomy, in post anesthesia care unit (PACU). The complication was related to tracheal tear occurring during excision of huge thyroid mass, encroaching trachea. But with timely assessment in PACU and prompt surgical intervention, we were able to save the patient. Vigilant observation in the early postoperative period is very important in patients undergoing thyroidectomy because early recognition is the key in saving patients with surgical emphysema, postoperatively.