Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Area of Science:

• Otolaryngology
• Endocrinology
• Surgical Complications

Background:

• Thyroid surgery, particularly total thyroidectomy, carries a risk of recurrent laryngeal nerve injury.
• Bilateral vocal cord paralysis is a rare but serious complication, potentially leading to airway compromise.

Observation:

• A 39-year-old woman developed stridor and required intubation post-total thyroidectomy for multinodular goitre.
• The complication is suspected to be bilateral vocal cord paresis, possibly related to high intraoperative nerve monitoring (IONM) settings.

Findings:

• The patient experienced acute airway distress following an uneventful thyroidectomy.
• High intraoperative nerve monitoring (IONM) settings were identified as a potential contributing factor to vocal cord paresis.

Implications:

• This case underscores the importance of vigilant monitoring and appropriate setting selection during intraoperative nerve monitoring (IONM).
• Careful management can prevent the need for tracheostomy in cases of post-thyroidectomy vocal cord paresis.