A hyalinizing trabecular tumor (HTT) of the thyroid gland is a very rare type of tumor. It is usually diagnosed incidentally during the examination for thyroid gland diseases that need thyroidectomy. Here we report a case of HTT in a 60-year-old male patient who presented with anterior neck swelling and underwent total thyroidectomy for a Bethesda category V nodule. The final histologic diagnosis of the left lobe was consistent with a hyalinized trabecular adenoma of the thyroid gland, or paraganglioma-like adenoma. We discuss the clinical picture and diagnostic approach, including the role of fine needle aspiration biopsy, and the pathologic features of HTT, with particular reference to the possible differential diagnosis.