Total Versus Completion Thyroidectomy: A Multidimensional Evaluation of Long-Term Vocal Alterations

Area of Science:

• Otolaryngology
• Thyroid Surgery
• Vocal Cord Function

Background:

• Total thyroidectomy (TT) and completion thyroidectomy (CT) are common surgeries.
• Vocal symptoms can occur post-surgery despite nerve preservation.
• Understanding vocal alterations without nerve injury is crucial.

Purpose of the Study:

• To analyze vocal alterations after TT and CT.
• To assess vocal changes via endoscopic findings, videolaryngostroboscopy (VLS), and acoustic parameters.
• To evaluate the impact on patients' quality of life post-surgery, excluding nerve injury.

Main Methods:

• 198 patients (126 TT, 72 CT) were analyzed.
• Preoperative and postoperative VLS and Voice Handicap Index (VHI) were performed.
• Acoustic Voice Analysis was conducted 12-18 months post-surgery.

Main Results:

• Completion thyroidectomy (CT) showed a higher rate of external branch of superior laryngeal nerve (EBSLN) injury than total thyroidectomy (TT).
• Both TT and CT patients had worse acoustic parameters and VHI scores than controls, even without nerve injury.
• CT group exhibited significantly poorer acoustic parameters and VHI scores compared to the TT group.

Conclusions:

• CT presents a higher surgical risk and greater vocal trauma than TT.
• Vocal loudness and self-perception are significantly worse after CT.
• Comprehensive pre- and post-operative voice analysis is essential due to multifactorial vocal alterations.