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Bilateral Hypoglossal Nerve Palsy After Thyroidectomy: A Case Report
Yuwei Gu1, Rongrong Lu2, Tingwei Wang2
1Department of Rehabilitation Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.
Ear, Nose, & Throat Journal
|June 23, 2026
Summary
This case study details a rare complication of thyroidectomy: bilateral hypoglossal nerve palsy. Despite treatment and rehabilitation, mild speech difficulties persisted, highlighting the need for careful preoperative assessment for potential nerve injury.
Area of Science:
- Neurology
- Otolaryngology
- Surgical Oncology
Background:
- Thyroidectomy is the primary treatment for well-differentiated thyroid carcinoma.
- Hypoglossal nerve injury is a rare but significant complication following thyroid surgery.
- Bilateral hypoglossal nerve palsy presents unique diagnostic and management challenges.
Purpose of the Study:
- To report a rare case of bilateral hypoglossal nerve palsy after thyroidectomy.
- To discuss the diagnostic workup and management of this complication.
- To emphasize the importance of preoperative risk assessment for hypoglossal nerve injury.
Main Methods:
- Case report of a 57-year-old female undergoing bilateral total thyroidectomy.
- Diagnostic evaluation included comprehensive imaging and electrophysiological studies.
- Management involved empirical steroid treatment and multidisciplinary neurorehabilitation.
Main Results:
- Bilateral hypoglossal nerve dysfunction was confirmed, despite anatomically intact nerves on re-exploration.
- Neurological improvement with steroid treatment was limited.
- Neurorehabilitation led to gradual improvement in swallowing function, with persistent mild dysarthria.
Conclusions:
- Bilateral hypoglossal nerve palsy is a rare neurological complication of thyroidectomy.
- Early diagnosis and intensive neurorehabilitation are crucial for functional recovery.
- Preoperative assessment of risk factors for hypoglossal nerve injury is essential to optimize surgical outcomes.
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