Background
Vocal cord paralysis is associated with extrathyroidal invasive malignancy. This study
was performed to analyze the presentation of patients with invasive thyroid malignancy
and to determine the preoperative symptomatic and radiographic correlates of vocal
cord paralysis.
Methods
In a group of 365 consecutive patients undergoing thyroidectomy, the group of 21 patients
with invasive thyroid malignancy was compared with the 344 patients who had benign
thyroid disease or noninvasive cancers.
Results
Preoperative recurrent laryngeal nerve paralysis was a robust marker for invasive
thyroid malignancy, being present in 70% of patients with invasive disease and only
0.3% of patients with noninvasive disease. Vocal cord paralysis was associated with
voice change in only one third of patients. Preoperative computed tomography was read
as positive for vocal cord paralysis in only 25% of patients.
Conclusions
Laryngoscopic examination is essential for the detection of vocal cord paralysis preoperatively.
Symptomatic voice assessment and radiographic evaluation are insufficient. Preoperative
vocal cord paralysis tracts with invasive disease and facilitates preoperative recognition
of disease extent, allowing for appropriate operative planning and central neck clearance
at first operation. Because of the prevalence (approximately 6% in our study) of invasive
thyroid disease, the importance of preoperative diagnosis of invasive disease in operative
planning and patient counseling, and the importance of vocal cord functional analysis
in recurrent laryngeal nerve management algorithms for nerves found infiltrated at
operation, and laryngoscopic examination is recommended for all patients undergoing
thyroid operation.
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Article info
Publication history
Accepted:
August 16,
2005
Received in revised form:
July 28,
2005
Received:
January 25,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
