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Delayed-onset vocal cord palsy after thyroidectomy occurring despite normal initial post-operative endoscopy.

Tianrui Ren1, Stephanie Manning1, James C Lee1,2

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Summary

Delayed-onset vocal cord palsy after thyroidectomy is rare but occurs even with normal nerve monitoring. Most patients recover vocal function within six months with conservative management and voice therapy.

Keywords:
endocrine surgeryintraoperative nerve monitoringneuropraxiarecurrent larngeal nerve injurythyroidectomyvocal cord palsy

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Area of Science:

  • Otolaryngology
  • Endocrinology
  • Surgical Complications

Background:

  • Recurrent laryngeal nerve (RLN) injury is a known complication of thyroidectomy.
  • Delayed-onset vocal cord palsy is a rare presentation, occurring despite normal intra-operative monitoring and initial post-operative assessments.
  • This complication can cause significant patient distress, necessitating recognition of its incidence and prognosis.

Purpose of the Study:

  • To report the first Australian series of delayed-onset vocal cord palsy following thyroidectomy.
  • To explore the prognosis, pathophysiological mechanisms, and recovery timeframe of this rare complication.
  • To aid in the recognition of delayed-onset vocal cord palsy, reassure affected patients, and guide early intervention for improved quality of life.

Main Methods:

  • Retrospective case series of seven patients with delayed-onset RLN palsy post-thyroidectomy.
  • All patients had normal pre-operative and immediate post-operative flexible nasoendoscopy (FNE) and intra-operative nerve monitoring.
  • Diagnosis confirmed via endoscopy, with serial FNE examinations to monitor recovery. Conservative management, including voice therapy, was employed.

Main Results:

  • Seven patients (43% male, median age 65) presented with delayed-onset RLN palsy at a median of 12 days post-surgery.
  • The complication occurred unilaterally in 86% of cases.
  • All patients recovered vocal cord function within a median of 24 weeks, with 86% recovering within six months. The incidence was 0.1%.

Conclusions:

  • Delayed-onset vocal cord palsy is a rare but distinct complication of thyroidectomy.
  • Prognosis is generally favorable, with most patients achieving functional recovery through conservative management and voice therapy.
  • Recognition and understanding of this condition are crucial for patient reassurance and timely intervention.