Other possible causes for hoarseness include paralysis of the vocal cord due to compression of the left recurrent laryngeal nerve from the goiter. Of concern is the possibility of malignant change within the goiter directly invading the recurrent laryngeal nerve. Fortunately, malignant change is rare within the thyroid gland.
When patients have a relatively low production of thyroxine such that the basal metabolic rate is reduced they become more susceptible to infection, including throat and upper respiratory tract infections.