Recurrent laryngeal nerve palsy associated with thyroiditis

Vocal characteristics in patients with thyroiditis

OBJECTIVE

The aim of the present study was to describe the vocal characteristics of patients with thyroiditis in a clinical setting.

MATERIALS AND METHODS

A total of 17 consecutive patients with the diagnosis of thyroiditis presenting to the endocrinology clinic were invited to participate in the study. A group of 29 healthy subjects were used as controls. They underwent acoustic analysis and a perceptual evaluation using the GRABS classification. The mean score of each parameter was computed, and the distribution of severity of each perceptual parameter were listed.

RESULTS

There was no significant difference in any of the acoustic parameters between the patients and the controls, and there was no significant difference in the mean score of all the perceptual parameters between the patients and the controls. Even when examining the distribution of the severity of evaluation, there was no significant difference between the patients and the controls, as well.

CONCLUSION

Patients with thyroiditis do not have abnormal perceptual vocal evaluation or acoustic findings compared with controls.

Management of the Recurrent Laryngeal Nerve in Suspected and Proven Thyroid Cancer

Vocal cord paralysis occurs with and without infiltration of the recurrent laryngeal nerve. Patients with no paralysis may have recurrent laryngeal nerve infiltration. We studied 262 patients with invasive thyroid carcinoma and an additional 480 patients that we operated on, and we offer an approach to the management of the recurrent laryngeal nerve during surgery for suspected or proven thyroid cancer. Because complete excision of papillary carcinoma with resection of the recurrent laryngeal nerve did not improve survival over incomplete excision, we recommend incomplete excision of papillary carcinoma infiltrating a functioning recurrent laryngeal nerve with postoperative I-131 and thyroid-stimulating hormone suppression. We observed (1) lymphoma and Reidel's thyroiditis causing paralysis with infiltration of the recurrent laryngeal nerve with recovery of function, (2) benign and malignant nodules causing paralysis without infiltration of the recurrent laryngeal nerve with recovery of function, and (3) infiltration of the recurrent laryngeal nerve without paralysis in lymphoma, Graves' disease, and thyroiditis. In surgery for a suspicious nodule with paralysis, identify the recurrent laryngeal nerve, resect it if it is infiltrated by carcinoma, and preserve it if not infiltrated or if infiltrated by any pathology besides carcinoma.

Acute bilateral vocal fold paresis as a symptom of benign thyroid disease

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.

Hashimoto's thyroiditis presenting with severe pressure symptoms--a case report

A extremely rare case of Hashimoto's thyroiditis presenting with pressure symptoms is described herein. A 50 year old Japanese woman was referred to our department with swelling of the anterior neck, facial edema and recent heavy snoring. Oto-rhinolaryngological examinations revealed no movement of the bilateral vocal cords, severe laryngeal edema and diffuse edema of the tongue and pharynx. These findings had apparently been induced by compression of the bilateral recurrent nerves and internal jugular veins by an enlarged thyroid gland. The results of thyroid function and autoimmune tests were compatible with a diagnosis of Hashimoto's disease and thus, total thyroidectomy with a tracheostomy was performed uneventfully. The resected specimen weighed 168 grams and was confirmed histologically to be Hashimoto's disease. Following her operation, all the above symptoms disappeared and 4 months later, the patient is well and asymptomatic.