Patients with huge thyroid tumors have characteristics such as long course of disease, tracheal displacement, and high risk of anesthesia and surgery. For known difficult airways, comprehensive perioperative assessment and airway management are essential. This article reports a successful case of awake tracheal intubation anesthesia [with extracorporeal membrane oxygenation (ECMO) backup] for a patient with a huge thyroid tumor, and summarizes the experience based on relevant literature, providing a reference for perioperative airway management of such patients.