We had a case of respiratory difficulty following total thyroidectomy due to bilateral vocal cord palsy. The patient was a 49-year-old female undergoing total thyroidectomy for papillary carcinoma of the thyroid. Anesthesia was performed uneventfully. Spontaneous respiration resumed after reversal of the neuromuscular blockade. However, after arriving at the postanesthesia care unit, she developed hypertension, anxiety, tachypnea, and inspiratory stridor during deep inspiration. Because the patient maintained adequate oxygen saturation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. During the operation, the surgeon experienced difficulty dissecting the bilateral recurrent laryngeal nerves from the surrounded tumor. So we consider that direct nerve injury was responsible for the bilateral vocal cord palsy. Movement of the right vocal cord recovered a week later.