It is a well-known fact that a recurrent laryngeal nerve (RLN) can be affected in any phase of thyroid disease management [3
]. The compression and invasion are the common ones. However it is not uncommon to see patients referred for management of vocal cord palsy with normal neck appeared to have a clinically-invisible thyroid mass.
The only sole presentation was a hoarse voice [4
]. This condition can be resulted from a compression that existed by a small lesion, but strategically located enough to cause compression to the nerve and ended the RLN up with neuropraxia. The symptom is easily recognized by patient as the voice change is a feature of concerned as compared to the slow-growing neck mass. As the long-list cause of vocal cord palsy need to be ruled out, a neck ultrasonography or computed tomography is warranted. Only from the radiological imaging the diagnosis can be confirmed and further investigation can be planned. It is interesting to note that in one of our case the vocal cord palsy recovered just after the fine needle aspiration done to the thyroid cyst that was located in the trachea-esophageal groove [4
]. Eventually the patient refused to continue further treatment as the voice normalized. In the other case, the voice recovered few months after lobectomy was performed to remove the compressing nodule [5