Background Thyroglossal duct cyst is the most common midline congenital swelling in the head and neck. This anomaly is very rare in elderly. It usually presents as a midline painless neck swelling. In rare cases, it may show abnormal extension into the larynx that manifests with dysphonia and laryngeal obstruction. Case report We report a case of thyroglossal cyst in a sixty five year old patient who presented with difficulty in breathing, and hoarseness of voice. Fiber optic laryngoscopy revealed fullness in the right vallecula and the right piriform fossa. The differential diagnosis on Ultrasound and Computed Tomography was thyroglossal cyst versus laryngocele. After surgical excision, dyspnea resolved and voice improved. Postoperative fiber optic laryngoscope revealed the disappearance of previous fullness. Histopathological examination confirmed the diagnosis of thyroglossal cyst. To the best of our knowledge, very few cases of thyroglossal cyst with laryngeal extension were encountered in literature, and in this study, we are reporting another case of this extremely rare condition.