Transient bilateral vocal cord paralysis after total thyroidectomy
Keywords:
transient vocal cord paralysis, bilateral vocal cord paralysis, recurrent laryngeal nerve, total thyroidectomyAbstract
บทคัดย่อ
ภาวะสายเสียงเป็นอัมพาตสองข้างหลังการผ่าตัดต่อมไทรอยด์ทั้งหมดเป็นภาวะแทรกซ้อนที่อันตรายถึงชีวิตเนื่องจากมีผลต่อการหายใจ ผู้ป่วยต้องได้รับการรักษาอย่างเร่งด่วน ในบทความนี้แสดงรายงานผู้ป่วยหญิงอายุ 60 ปี มาพบแพทย์ด้วยก้อนขนาดใหญ่ที่ต่อมไทรอยด์ทั้งสองข้างและได้รับการผ่าตัดต่อมไทรอยด์ทั้งหมด หลังผ่าตัดมีภาวะสายเสียงเป็นอัมพาตสองข้าง ผู้ป่วยได้รับการใส่ท่อช่วยหายใจและติดตามประเมินการเคลื่อนไหวของสายเสียงและทางเดินหายใจ พบว่าสายเสียงกลับมาทำงานได้ในวันที่ 7 หลังผ่าตัดและสามารถถอดท่อช่วยหายใจได้โดยไม่ได้รับการเจาะคอ
Abstract
Bilateral vocal cord paralysis after total thyroidectomy is a life-threatening complication by causing compromised airway. It is an emergency condition that requires immediate treatment.This article reports a 60-year-old woman patient who presented with large thyroid nodules in both thyroid lobes and underwent total thyroidectomy. Postoperatively, the patient had bilateral vocal fold paralysis and was immediately treated with endotracheal intubation. The patient’s airway and vocal fold movement were then serially evaluated. It was found that the vocal fold movement returned at post-op day 7 and the patient can be safely extubated without the requirement of tracheostomy.
References
1. Lo C-Y, Kwok K-F, Yuen P-W. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000;135(2):204-7.
2. Zakaria HM, Al Awad NA, Al Kreedes AS, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 2011;26(1):34.
3. Cannizzaro MA, Bianco SL, Picardo MC,et al. How to avoid and to manage post-operative complications in thyroid surgery. Updates Surg 2017;69(2):211-5.
4. Ayala MA, Yencha MW. Outpatient thyroid surgery in a low-surgical volume hospital. World J Surg 2015;39(9):2253-8.
5. Chou F-F, Hsu C-M, Lai C-C, et al. Bilateral vocal cord palsy after total thyroidectomy–A new treatment–Case reports. Int J Surg Case Rep 2017;38:32-6.
6. Kasemsuwam L, Nubthuenetr S. Recurrent larymgeal nerve paralysis: a complication of thyroidectomy. J Otolaryngol 1997;26(6):365-7.
7. Cherian A, Balachander H, Nagappa M,et al. Bilateral vocal cord palsy following endotracheal intubation: a case report.J Clin Anesth 2010;22(7):562-4.
8. Jeong DM, Kim GH, Kim JA, et al.Transient bilateral vocal cord paralysis after endotracheal intubation with doublelumen tube-A case report. Korean J Anesth 2010;59(Suppl):S9.
9. Cavo Jr JW. True vocal cord paralysis following intubation. Laryngoscope 1985;95(11):1352-9.
10. Endo K, Okabe Y, Maruyama Y, et al. Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol 2007;28(2):126-9.
11. Inomata S, Nishikawa T, Suga A, et al.Transient bilateral vocal cord paralysis after insertion of a laryngeal mask airway.Anesthesiology 1995;82(3):787-8.
12. Sinagra DL, Montesinos MR, Tacchi VA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury.J Am Coll Surg 2004;199(4):556-60.
13. Schulte KM, Röher HD. Complications in the surgery of benign thyroid disease. Acta Chirurg Austriaca 2001;33(4):164-72.
14. Wakayama E, Sugimoto K, Mori Y, et al.A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery underintraoperative nerve monitoring. Masui
2012;61(4):407-10.
15. Chen HC, Pei YC, Fang TJ. Risk factors for thyroid surgery–related unilateral vocal fold paralysis. Laryngoscope 2019;129(1):275-83.
16. Vetshev P, Yankin P, Zhivotov V, et al. Risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. Khirurgiia 2019(4):
5-14.
17. Enomoto K, Uchino S, Watanabe S, et al.Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery 2014;155(3):522-8.
18. Godballe C, Madsen AR, Sørensen CH, et al. Risk factors for recurrent nerve palsyJ Med Health Sci Vol.27 No.1 April 2020 179 after thyroid surgery: a national study of patients treated at Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol 2014;271(8):2267-76.
19. Büyükcam F, Sönmez FT, Şahinli H. A delayed diagnosis: stridor secondary to hypocalcemia. Int J Emerg Med 2010;3(4):461.
20. Harness JK, Fung L, Thompson NW, et al.Total thyroidectomy: complications and technique. World J Surg 1986;10(5):781-5.
21. British Association of Endocrine Surgeons.Guidelines for the Surgical Management of Endocrine Disease and Training Requirements for Endocrine Surgery[Internet]. London (UK): Royal College of Surgeons; 1999 [revised 2006; cited 2019].Available from: https://www.baets.org.uk/wp-content/uploads/2013/02/BAETSGuidelines-2003.pdf.
22. Adam MA, Thomas S, Youngwirth L,et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017;265(2):402-7.
23. Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136(6):1310-22.
24. Dionigi G, Wu C-W, Kim HY, et al.Severity of recurrent laryngeal nerve injuries in thyroid surgery. World J Surg 2016;40(6):1373-81.
25. Steurer M, Passler C, Denk DM, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002;112(1):124-33.
26. Rice DH, Cone-Wesson B. Intraoperative recurrent laryngeal nerve monitoring.O t o l a r y n g o l H e a d N e c k S u r g 1991;105(3):372-5.
27. Serpell JW, Lee JC, Yeung MJ, et al. Differential recurrent laryngeal nerve palsy rates after thyroidectomy. Surgery 2014;156(5):1157-66.
28. Zheng S, Xu Z, Wei Y, et al. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—a meta-analysis. J Formos Med Assoc 2013;112(8):463-72.
29. Bai B, Chen W. Protective effects of intraoperative nerve monitoring (IONM) for recurrent laryngeal nerve injury in thyroidectomy: meta-analysis. Sci Rep 2018;8(1):7761.
30. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery:laryngeal palpation. World J Surg 2004;28(8):755-60.
31. Reiter R, Pickhard A, Smith E, et al. Vocal cord paralysis--analysis of a cohort of 400 patients. Laryngorhinootologie 2015;94(2):91.
32. Lang BH-H, Lo C-Y, Wong KP, et al. Should an involved but functioning recurrent laryngeal nerve be shaved or resected in a locally advanced papillary thyroid carcinoma? Ann Surg Oncol 2013;20(9):2951-7.
33. Khan JS. Recurrent laryngeal nerve in thyroid surgery: is routine identification necessary? J RMC 2008;12(1):16-8.
34. Reiter R, Pickhard A, Smith E, et al. Vocal cord paralysis--analysis of a cohort of 400 patients. Laryngorhinootologie 2015;94(2):91-6.
35. Misron K, Balasubramanian A, Mohamad I, et al. Bilateral vocal cord palsy post thyroidectomy: lessons learnt. BMJ Case Rep 2014;2014:bcr2013201033.
36. Schietroma M, Cecilia EM, Carlei F, et al. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery:a
randomized double-blind placebocontrolled trial. JAMA Otolaryngol Head Neck Surg 2013;139(5):471-8.
37. Kong X, Sun X, Zhang J. The protective role of Mecobalamin following optic nerve crush in adult rats. Yan Ke Xue Bao 2004;20(3):171-7.
38. Suzuki K, Tanaka H, Ebara M, et al.Electrospun nanofiber sheets incorporating methylcobalamin promote nerve regeneration and functional recovery in a rat sciatic nerve crush injury model. Acta Biomater 2017;53:250-9.
2. Zakaria HM, Al Awad NA, Al Kreedes AS, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 2011;26(1):34.
3. Cannizzaro MA, Bianco SL, Picardo MC,et al. How to avoid and to manage post-operative complications in thyroid surgery. Updates Surg 2017;69(2):211-5.
4. Ayala MA, Yencha MW. Outpatient thyroid surgery in a low-surgical volume hospital. World J Surg 2015;39(9):2253-8.
5. Chou F-F, Hsu C-M, Lai C-C, et al. Bilateral vocal cord palsy after total thyroidectomy–A new treatment–Case reports. Int J Surg Case Rep 2017;38:32-6.
6. Kasemsuwam L, Nubthuenetr S. Recurrent larymgeal nerve paralysis: a complication of thyroidectomy. J Otolaryngol 1997;26(6):365-7.
7. Cherian A, Balachander H, Nagappa M,et al. Bilateral vocal cord palsy following endotracheal intubation: a case report.J Clin Anesth 2010;22(7):562-4.
8. Jeong DM, Kim GH, Kim JA, et al.Transient bilateral vocal cord paralysis after endotracheal intubation with doublelumen tube-A case report. Korean J Anesth 2010;59(Suppl):S9.
9. Cavo Jr JW. True vocal cord paralysis following intubation. Laryngoscope 1985;95(11):1352-9.
10. Endo K, Okabe Y, Maruyama Y, et al. Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol 2007;28(2):126-9.
11. Inomata S, Nishikawa T, Suga A, et al.Transient bilateral vocal cord paralysis after insertion of a laryngeal mask airway.Anesthesiology 1995;82(3):787-8.
12. Sinagra DL, Montesinos MR, Tacchi VA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury.J Am Coll Surg 2004;199(4):556-60.
13. Schulte KM, Röher HD. Complications in the surgery of benign thyroid disease. Acta Chirurg Austriaca 2001;33(4):164-72.
14. Wakayama E, Sugimoto K, Mori Y, et al.A case of bilateral recurrent laryngeal nerve palsy after thyroid surgery underintraoperative nerve monitoring. Masui
2012;61(4):407-10.
15. Chen HC, Pei YC, Fang TJ. Risk factors for thyroid surgery–related unilateral vocal fold paralysis. Laryngoscope 2019;129(1):275-83.
16. Vetshev P, Yankin P, Zhivotov V, et al. Risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. Khirurgiia 2019(4):
5-14.
17. Enomoto K, Uchino S, Watanabe S, et al.Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery 2014;155(3):522-8.
18. Godballe C, Madsen AR, Sørensen CH, et al. Risk factors for recurrent nerve palsyJ Med Health Sci Vol.27 No.1 April 2020 179 after thyroid surgery: a national study of patients treated at Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol 2014;271(8):2267-76.
19. Büyükcam F, Sönmez FT, Şahinli H. A delayed diagnosis: stridor secondary to hypocalcemia. Int J Emerg Med 2010;3(4):461.
20. Harness JK, Fung L, Thompson NW, et al.Total thyroidectomy: complications and technique. World J Surg 1986;10(5):781-5.
21. British Association of Endocrine Surgeons.Guidelines for the Surgical Management of Endocrine Disease and Training Requirements for Endocrine Surgery[Internet]. London (UK): Royal College of Surgeons; 1999 [revised 2006; cited 2019].Available from: https://www.baets.org.uk/wp-content/uploads/2013/02/BAETSGuidelines-2003.pdf.
22. Adam MA, Thomas S, Youngwirth L,et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017;265(2):402-7.
23. Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136(6):1310-22.
24. Dionigi G, Wu C-W, Kim HY, et al.Severity of recurrent laryngeal nerve injuries in thyroid surgery. World J Surg 2016;40(6):1373-81.
25. Steurer M, Passler C, Denk DM, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002;112(1):124-33.
26. Rice DH, Cone-Wesson B. Intraoperative recurrent laryngeal nerve monitoring.O t o l a r y n g o l H e a d N e c k S u r g 1991;105(3):372-5.
27. Serpell JW, Lee JC, Yeung MJ, et al. Differential recurrent laryngeal nerve palsy rates after thyroidectomy. Surgery 2014;156(5):1157-66.
28. Zheng S, Xu Z, Wei Y, et al. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—a meta-analysis. J Formos Med Assoc 2013;112(8):463-72.
29. Bai B, Chen W. Protective effects of intraoperative nerve monitoring (IONM) for recurrent laryngeal nerve injury in thyroidectomy: meta-analysis. Sci Rep 2018;8(1):7761.
30. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery:laryngeal palpation. World J Surg 2004;28(8):755-60.
31. Reiter R, Pickhard A, Smith E, et al. Vocal cord paralysis--analysis of a cohort of 400 patients. Laryngorhinootologie 2015;94(2):91.
32. Lang BH-H, Lo C-Y, Wong KP, et al. Should an involved but functioning recurrent laryngeal nerve be shaved or resected in a locally advanced papillary thyroid carcinoma? Ann Surg Oncol 2013;20(9):2951-7.
33. Khan JS. Recurrent laryngeal nerve in thyroid surgery: is routine identification necessary? J RMC 2008;12(1):16-8.
34. Reiter R, Pickhard A, Smith E, et al. Vocal cord paralysis--analysis of a cohort of 400 patients. Laryngorhinootologie 2015;94(2):91-6.
35. Misron K, Balasubramanian A, Mohamad I, et al. Bilateral vocal cord palsy post thyroidectomy: lessons learnt. BMJ Case Rep 2014;2014:bcr2013201033.
36. Schietroma M, Cecilia EM, Carlei F, et al. Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery:a
randomized double-blind placebocontrolled trial. JAMA Otolaryngol Head Neck Surg 2013;139(5):471-8.
37. Kong X, Sun X, Zhang J. The protective role of Mecobalamin following optic nerve crush in adult rats. Yan Ke Xue Bao 2004;20(3):171-7.
38. Suzuki K, Tanaka H, Ebara M, et al.Electrospun nanofiber sheets incorporating methylcobalamin promote nerve regeneration and functional recovery in a rat sciatic nerve crush injury model. Acta Biomater 2017;53:250-9.
Downloads
Published
2020-04-29
How to Cite
1.
Wongwattana P, Wiriyaamornchai P. Transient bilateral vocal cord paralysis after total thyroidectomy. J Med Health Sci [Internet]. 2020 Apr. 29 [cited 2024 Dec. 19];27(1):173-80. Available from: https://he01.tci-thaijo.org/index.php/jmhs/article/view/241835
Issue
Section
Case report/Case series (บทความรายงานผู้ป่วย)
