Objective: To discuss the challenges in diagnosing and managing a patient with an anterior neck mass and dysphonia of tuberculous origin. Study Design: Case Report Setting: Tertiary Private Hospital Patient: A 59-year-old Filipino female with a chief complaint of dysphonia. Clinical Summary: The patient presented with dysphonia, leading to a Flexible Nasopharyngolaryngoscopy revealing immobility of the right true vocal cord, adequate glottic opening, and spindle-shaped glottic closure. Ultrasonography identified multiple nodules and cervical lymph nodes. A fine needle aspirate biopsy yielded Bethesda Category III results, indicating atypia with undetermined significance. Subsequently, the patient underwent total thyroidectomy and excision of the right paratracheal mass, with a rush frozen section showing chronic granulomatous inflammation and no tumor. Histopathological analysis confirmed Mycobacterium tuberculosis (MTB) infection and chronic granulomatous lymphadenitis of tuberculous origin. After completing 6 months of anti-tuberculous treatment, the patient showed clinico- radiological improvement but did not recover from recurrent laryngeal nerve injury.