Clinical presentation: a 53 year-old man was referred for an evaluation of a thyroid nodule discovered on an evaluation of intermittent palsy of the left recurrent nerve beginning 4 months earlier. The patient was not aware of his goiter.

Palpation: a large firm nodule in the left lobe.

Laboratory test: euthyroidism with TSH 1.37 mIU/L.

Ultrasonography: there was a large moderately hypoechogenic nodule in the left lobe. The nodule presented a halo sign and perinodular blood flow.

Cytological report: Hürthle-cell tumor.

Histopathology: disclosed Hürthle-cell adenoma.

Comment: palsy of the recurrent nerve without laryngological reason is a very suspicious sign of thyroid carcinoma. Benign lesions only very rarely cause palsy except for rapidly developing enlargement caused by cystic degeneration.