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

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.