A case of thyroid storm in a patient with persistent recurrent laryngeal nerve paralysis with review of literature

Patients with thyroid disease, particularly thyroid cancer, may sometimes present with recurrent laryngeal nerve paralysis. However, cases of Graves’ disease associated with recurrent laryngeal nerve paralysis are rare. Previous reports suggest that such paralysis in Graves’ disease is typically transient. Here, we present a case of a 48-year-old woman who developed thyroid storm secondary to Graves’ disease and experienced persistent recurrent laryngeal nerve paralysis for two years. The patient presented with hoarseness, dysphagia, and severe thyrotoxicosis. Laryngoscopy revealed left vocal cord paralysis. She received standard treatment for thyroid storm and subsequently underwent radioisotope therapy. Despite improvement in thyrotoxicosis and goiter, her vocal cord paralysis remained unchanged. No other causes of nerve injury were identified. The persistent paralysis was likely due to prolonged compression of the recurrent laryngeal nerve by the enlarged goiter. Unlike previous cases with transient dysfunction, nerve recovery did not occur even after successful treatment. To the best of our knowledge, this is the first reported case of thyroid storm in a patient with persistent recurrent laryngeal nerve paralysis. This case highlights the need for early and continuous management of Graves’ disease to prevent permanent nerve damage, even in non-malignant conditions.