Laryngeal and vocal alterations after thyroidectomy

To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.

Methods:

Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).

Results:

Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21).

Conclusion:

Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

KEYWORDS
Thyroidectomy; Dysphonia; Laryngeal paralysis; Hoarseness; Acoustic analysis

Parameters	Gender	Moments				p-Value
		Pre	1st post	2nd post	3rd post
F0	F	203.9^a (118.28-293.53)	193.3^b (76.47-293.53)	191.7^b (109.11-293.59)	196.0^b (86.19-276.05)	<0.00
	M	124.5 (85.10-156.61)	116.7 (0.00-158.21)	110.2 (91.02-186.92)	116.3 (89.47-186.92)	0.302
p-Value	<0.001	<0.001	<0.001	<0.001
Jitter (%)	F	1.03 (0.27-6.54)	1.26 (0.32-18.31)	0.97 (0.25-10.54)	0.94 (0.18-5.22)	0.64
	M	1.09 (0.40-2.68)	1.09 (0.27-4.09)	0.71 (0.32-3.29)	1.28 (0.32-6.25)	0.133
p-Value	0.56	0.257	0.144	0.124
PPQ	F	0.59 (0.15-3.78)	0.70 (0.19-13.59)	0.53 (0.14-6.57)	0.54 (0.11-2.93)	0.497
	M	0.63 (0.23-1.49)	0.63 (0.17-2.60)	0.43 (0.19-2.21)	0.74 (0.16-2.90)	0.133
p-value	0.507	0.341	0.218	0.111
Shimmer (%)	F	3.24 (0.92-15.81)	3.34 (1.12-15.70)	3.28 (1.29-14.78)	3.10 (1.04-18.55)	0.211
	M	3.65 (1.74-16.43)	4.48 (1.83-11.49)	4.36 (1.42-12.16)	4.36 (2.68-16.32)	0.184
p-Value	0.529	0.081	0.157	0.006
APQ	F	2.36^ab (0.70-9.57)	2.33^a (0.86-12.02)	2.28^ab (0.97-11.48)	2.12^b (0.76-12.50)	0.039
	M	3.04 (0.36-11.44)	3.30 (1.30-8.20)	3.30 (1.29-9.91)	3.07 (1.96-11.03)	0.183
p-Value	0.095	0.019	0.010	<0.001
NHR	F	0.14 (0.05-0.32)	0.14 (0.07-0.50)	0.14 (0.07-0.40)	0.14 (0.07-0.48)	0.954
	M	0.15 (0.07-0.23)	0.14 (0.08-0.27)	0.14 (0.08-0.25)	0.14 (0.09-0.44)	0.995
p-Value	0.096	0.342	0.440	0.325
SPI	F	9.31 (1.16-63.08)	9.17 (1.38-54.75)	8.86 (1.94-56.64)	9.34 (1.94-56.64)	0.313
	M	12.02 (5.89-31.71)	14.90 (5.36-42.08)	11.28 (3.06-40.67)	12.44 (0.59-30.62)	0.825
p-Value	0.041	0.021	0.103	0.183

Videolaryngoscopy	Moments
	Pre n (%)	1st post n (%)	2nd post n (%)	3rd post n (%)	4th post n (%)
Normal	144 (95.3)	100 (66.2)	125 (82.8)	134 (88.7)	141 (93.4)
RLN paralysis	0 (0.0)	32 (21.2)	23 (15.2)	17 (11.3)	10 (6.6)
SLN paralysis	0 (0.0)	2 (1.3)	1 (0.7)	0 (0.0)	0 (0.0)
Projection to hypopharynx	7 (4.7)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Edema/hematoma	0 (0.0)	15 (10.0)	2 (1.3)	0 (0.0)	0 (0.0)
Granuloma	0 (0.0)	2 (1.3)	0 (0.0)	0 (0.0)	0 (0.0)
Total	151 (100.0)	151 (100.0)	151 (100.0)	151 (100.0)	151 (100.0)

Type of surgery n (%)	Histopathology n (%)			Total
	Colloid goiter	Thyroiditis	Cancer
Lobectomy with isthmusectomy (LI)	33 (82.5)	5 (12.5)	2 (5.0)	40 (100.0)
Total thyroidectomy (TT)	43 (48.9)	3 (3.4)	42 (47.7)	88 (100.0)
Thyroidectomy + lymph node dissection (TT + LND)	0 (0.0)	0 (0.0)	23 (100.0)	23 (100.0)
Total	76 (50.3)	8 (5.3)	67 (44.4)	151(100.0)

Patients with paralysis/paresis	Types of surgery
	LI n (%)	TT n (%)	TT + LND n (%)	Total n (%)
RLN	6 (17.6)	17 (50.0)	9 (26.6)	32 (94.2)
SLN	1 (2.9)	0 (0.0)	1 (2.9)	2 (5.8)
Total	7 (20.6)	17 (50.0)	10 (29.4)	34 (100.0)

Patients with paresis/paralysis	Histology			Total
	Goiter	Thyroiditis	Carcinoma
RLN	12 (35.3)	0 (0.0)	20 (58.9)	32 (94.2)
SLN	1 (2.9)	0 (0.0)	1 (2.9)	2 (5.8)
Total	13 (38.2)	0 (0.0)	21 (61.8)	34 (100.0)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:rmartins@fmb.unesp.br (R.H. Martins).

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Laryngeal and vocal alterations after thyroidectomy☆ ☆ Please cite this article as: Iyomasa RM, Tagliarini JV, Rodrigues SA, Tavares EL, Martins RH. Laryngeal and vocal alterations after thyroidectomy. Braz J Otorhinolaryngol. 2019;85:3-10.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Laryngeal and vocal alterations after thyroidectomy^☆ ☆ Please cite this article as: Iyomasa RM, Tagliarini JV, Rodrigues SA, Tavares EL, Martins RH. Laryngeal and vocal alterations after thyroidectomy. Braz J Otorhinolaryngol. 2019;85:3-10.