Co-existence of multiple pathologies affecting a patient poses a challenge in the diagnosis and management. A rare combination of early tongue cancer, maxillary fungal rhinosinusitis, calcified thyroid nodule and primary hyperparathyroidism in a 70-year-old female is described. The evidences used for disease probabilities based on diagnostic results and effectivess of treatment modalities are presented. The decision-making process to come up with an individualized management is discussed.