Paragangliomas are rare neuroendocrine tumors that derive from the extra-adrenal paraganglia. In the head and neck region, these neoplasms most commonly arise from the carotid body, the vagus nerve, and the jugulotympanic area. We describe the case of an 87-year-old woman with an incidental finding of a clinically, radiologically, and cytologically presumed retrosternal goiter. During a left thyroid lobectomy, she was found to have a mass that originated in the left recurrent laryngeal nerve. The mass was resected, and subsequent histopathologic examination found it to be a paraganglioma. Follow-up evaluation confirmed the expected finding of a left-sided vocal fold palsy. To the best of our knowledge, this is the first reported case of a paraganglioma arising from a recurrent laryngeal nerve.