Laryngeal and vocal alterations after thyroidectomy

Publication date: Available online 21 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Renata Mizusaki Iyomasa, José Vicente Tagliarini, Sérgio Augusto Rodrigues, Elaine Lara Mendes Tavares, Regina Helena Garcia Martins
IntroductionDysphonia is a common symptom after thyroidectomy.ObjectiveTo analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.MethodsProspective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).ResultsAmong the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy (LI) n=40, total thyroidectomy (TT) n=88, thyroidectomy+lymph node dissection (TT+LND) n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (LI n=6; TT n=17; TT+LND n=9) and 2 superior laryngeal nerve (LI n=1; TT+LND n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21).ConclusionVocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.



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