Invasive Insular Thyroid Carcinoma Presenting as Nonparalytic Dysphonia

Background: Patients with suspected thyroid malignancy often undergo preoperative laryngeal examination with a focus on vocal fold mobility. We present the unique case of a patient with invasive thyroid carcinoma who presented with dysphonia despite intact vocal fold motion. Case Report: A 73-year-old female with a remote thyroid lobectomy presented with dysphonia. Thyroid ultrasound and fine-needle aspiration revealed a 1.1-cm nodule consistent with a colloid cyst. Videostroboscopy demonstrated mild laryngeal stenosis at the glottis and infraglottis with no evidence of paralysis. After failed medical therapy, the patient underwent microlaryngoscopy with biopsy of her infraglottic fullness, with histopathology reporting squamous epithelium without nucelar atypia. After several weeks of worsening dysphonia and persistent infraglottic fullness, she underwent repeat microlaryngoscopy with biopsy. On postoperative day 1, she developed dyspnea and stridor refractory to maximal medical management. To secure the...