Vocal cord paralysis and goiter are 2 common problems encountered in otolaryngology practice. Their coexistence, however, should arouse suspicion of the presence of malignant thyroid disease. Primary tracheal cancer is uncommon, and its incidence is very low compared with laryngeal cancer. Primary tracheal tumors can cause recurrent nerve palsy. We report here a rare case of vocal cord paralysis caused by a clinically occult tracheal squamous cell carcinoma in an 80-year-old patient with coincidental huge multinodular goiter.