Primary thyroid lymphoma is defined as a lymphoma involving either the thyroid gland alone or both the thyroid gland and neck lymph nodes, without contiguous spread or distant metastases from other areas of involvement at the time of diagnosis. Despite its rarity, prompt recognition of primary thyroid lymphoma is essential due to its distinct management, which differs significantly from the treatment approaches for other neoplasms of the thyroid gland. Herein, we report a 64 years- old female patient who complained of hoarseness, and was diagnosed as thyroid lymphoma with unilateral vocal fold paralysis. After chemotherapy, vocal fold paralysis was relieved and the patient’s hoarseness was improved.