[Predictive factors of vocal cord paralysis following thyroid surgery]

One of the most serious potential complications of thyroid surgery is temporary or permanent dysfunction of the recurrent laryngeal nerve. According to the literature, the development of nerve injury is influenced by several predictive factors, including demographic, surgical and pathological factors.

The aim of our research was to determine the prevalence of temporary and permanent vocal cord paralysis following thyroid surgery in our patient population, and to identify preoperative factors that may be associated with the development of paralysis.

We retrospectively analyzed the data of patients who underwent thyroid surgery between January 1, 2022 and March 31, 2024. In addition to demographic data, we examined the surgical indication, interventional procedure and postoperative histological results. Fisher's exact test and multivariate regression analysis were used to analyze whether age 65 years or older, malignant indication, and total thyroidectomy had prognostic significance for recurrent laryngeal nerve injury.

During the study period, a total of 155 operations were performed on 153 patients (125 women, 30 men; mean age: 53.7 years) (nerve at risk: 227). Of these, 143 were primary operations, 11 were completion thyroidectomies and 1 was reoperation; 83 cases were lobectomy, 72 cases were total thyroidectomy. The surgical indication was benign in 123 cases (category II-IV according to The Bethesda System for Reporting Thyroid Cytopathology [2023], drug-resistant hyperthyroidism, compression symptoms), and malignant in 32 cases (category V-VI, contralateral malignancy, cold nodule). Histological examination confirmed 128 benign and 27 malignant lesions. Immediate postoperative laryngeal dysmotility occurred in 18 cases (nerve at risk: 19; 8.4%). 4 patients were lost to follow-up, so 11 cases (5.0% of 220 nerve at risk) proved to be temporary and 3 cases (1.4% of 220 nerve at risk) proved to be permanent paralysis. Statistical analysis did not confirm any of the examined factors as independent predictors.

The incidence of postoperative laryngeal paralysis was in line with international data, and none of the examined potential risk factors were able to prove their prognostic significance, so the personalized risk assessment still relies primarily on literature data in our practice. Orv Hetil. 2026; 167(26): 1034-1040.