A 51-year-old female presented with history of left thyroid lobe swelling for 3-4 years, which was gradually increasing in size with no compressive or any associated symptoms. On examination, she had a left thyroid nodule which was nontender and moving with swallowing with no palpable lymph node. The systemic examination was unremarkable, and she was clinically euthyroid. Her initial workup included FNAC of left thyroid lobe which showed follicular lesion with prominent Hurthle cell. Her Technetium 99 thyroid scintigraphy revealed cold nodule in left lobe of thyroid. Ultrasound of thyroid showed a left sided hypoechoic nodule measuring 3.3 x 2.4 cm with minimal peripheral vascularity. The right lobe was normal in size with few small solid and cystic nodules. Her chest X-ray was normal. Her complete blood count and routine biochemistry were essentially normal. She underwent total thyroidectomy, and her histopathology report showed, follicular adenomaoncocytic variety (Hurthle cell adenoma), foci of granulomatous inflammation in the left lobe, and benign nodular hyperplasia with foci of chronic granulomatous inflammation along with necrosis with possibility of tuberculosis in the right lobe. She was started on ATT with four drug regimen for the first three months followed by three drugs regimen for the next six months along with Thyroxine 100 ug daily. She completed her treatment and remained asymptomatic as she was before.