Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Area of Science:

• Ophthalmology
• Endocrinology
• Neurosurgery

Background:

• The oculosympathetic pathway is a critical three-neuron system controlling sympathetic eye innervation.
• Neck surgeries, including thyroidectomy, carry a rare risk of injuring this pathway, potentially leading to Horner's syndrome.
• Horner's syndrome presents as unilateral ptosis, miosis, and anhidrosis.

Observation:

• A 23-year-old female developed unilateral ptosis and miosis post-thyroidectomy for papillary thyroid carcinoma.
• Ophthalmological assessment confirmed right-sided Horner's syndrome, with symptoms reversing upon apraclonidine administration.
• No compressive hematoma or seroma was identified, indicating conservative management was appropriate.

Findings:

• The patient experienced partial ptosis improvement at six weeks post-surgery.
• Blurred vision was reported due to refractive changes from impaired pupillary function.
• Recovery from post-thyroidectomy Horner's syndrome is challenging to predict due to limited data.

Implications:

• Pre-operative counseling regarding the risk of Horner's syndrome following thyroidectomy is crucial for informed consent.
• Residual Horner's syndrome can cause functional deficits and cosmetic concerns.
• Further research is needed to better understand and manage this rare complication.