Pseudoarthrosis of the thyro-hyoid cartilage is a rare case and even rarer when idiopathic in origin. The literature review of pseudoarthrosis of the thyro-hyoid complex has been documented only in post-mortem and case series journals. We present a unique case of a left thyro-hyoid cartilage pseudoarthrosis which required operative management. We present a 68 year old male who was initially reviewed in a tertiary center in West Melbourne from a regional hospital centre for ongoing care of parapharyngeal infection. After resolution of the parapharyngeal infection, the patient was noted to have ongoing left lateral pharyngeal wall fullness. A CT neck was repeated which showed hypertrophy of the left superior horn of the thyroid cartilage which was well corticated with no bony erosions suggestive of a chronic pathology. Upon further history, it was noted that the patient has always had a supraglottic voice and a heavy smoker, never had any dyspnoea or dysphagia that was worsening. The patient underwent a transcervical excision of pseudoarthrosis. Histological appearance showed that the thyroid cartilage appeared to be ossified with a central zone of hyaline consistent with pseudoarthrosis of the thyroid cartilage. Pseudoarthrosis of thyroid cartilage resulting in symptoms is rare. This case highlights the diagnostic uniqueness of a person who can present with dysphagia with anatomical respect to larynx and aerodigestive tract. Clinicians should be aware of the rare anatomical variants of thyroid cornu which can result in symptoms of dysphagia which should be considered as differentials.