A 50-year-old, white woman presented with a 5-month history of failure to thrive and hoarseness. The patient described a progressive decline in her voice, resulting in inability to speak. Concurrently, dysphagia, nausea, and alternating episodes of diarrhea and constipation developed, which resulted in the loss of 35 lb. Vertigo and dizziness became so severe that the patient was eventually unable to stand without falling. She also described headaches, anxiety attacks, an inability to move her eyes, and loss of visual acuity. The patient presented to an outside hospital where otolaryngologic evaluation revealed bilateral vocal cord paralysis. The patient underwent tracheostomy, and a gastrostomy tube was placed for severe weight loss. The patient was transferred to our institution for further evaluation.