Vocal cord paralysis and psychopathology. Data and clinical issues

The nature and cause of psychiatric symptoms associated with the posthyroidectomy bilateral abductor vocal cord paralysis (BAVCP) syndrome are analyzed. The postthyroidectomy BAVCP syndrome is characterized by normal voice, airway obstruction, hypothyroidism, hypoparathyroidism, and psychiatric manifestations. Forty-five (35.2%) of 128 patients with postthyroidectomy BAVCP syndrome had psychiatric manifestations of some kind. The following four categories of psychiatric problems were found: (1) preexisting psychiatric symptoms exacerbated by the postthyroidectomy BAVCP syndrome, (2) psychiatric symptoms initiated by the syndrome, (3) psychiatric symptoms that were etiologically distinct from the syndrome, and (4) misdiagnosis. The variety of psychiatric symptoms, as well as the difficulty in determining the cause of the symptoms, makes it essential that surgeons, internists, and psychiatrists cooperate in the treatment of patients with the postthyroidectomy.