We report a case of acute hemorrhagic cyst of the thyroid gland in a female patient presenting with recurrent laryngeal nerve (RLN) palsy that was treated surgically, with resolution of her symptoms. Cystic lesions of the thyroid are very common, and most patients present with minimal symptoms. Rarely, acute hemorrhage into a thyroid cyst can cause pain and mild dysphagia, but acute dysphonia is uncommon. Treatment is usually conservative in simple cystic lesions but those with compressive symptoms require intervention, with aspiration or rarely surgery.
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