A 56-year-old woman was seen in the emergency department for stridor and severe respiratory distress. She reported progressive dyspnea and hoarseness of a few months’ duration associated with dysphagia and odynophagia. The patient is a heavy smoker, is not an alcoholic, and has been treated for asthma since the initiation of her symptoms. Her medical history is notable for Graves disease, which was surgically treated by total thyroidectomy 20 years ago. The thyroidectomy was complicated by unilateral vocal cord paralysis, for which she received Teflon (DuPont, Wilmington, Del) injections. Fiberoptic nasopharyngeal laryngoscopy showed a left transglottic submucosal mass extending to the subglottic region and fixing the left true cord. Findings from the remainder of the head and neck examination were negative. Results of blood studies were negative. Computed tomography of the neck showed a large mass involving the left vocal cord that was eroding the left thyroid cartilage and causing narrowing of the laryngeal airway in its transverse diameter. There was supraglottic and subglottic extension of the mass, with more evidence of enlarged bilateral cervical lymph nodes on the left side (Figure 1).