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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Invasive disease.in: Randolph G.W. Surgery of the thyroid and parathyroid glands. Saunders, Philadelphia2003: 343-349
- Locally invasive papillary thyroid carcinoma 1940-1990.Head Neck. 1994; 16: 165-172
- Advantages of RLN identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 100 nerves at risk.Laryngoscope. 2002; 112: 124
- Differentiated carcinoma of the thyroid with extra thyroidal extension.Am J Surg. 1995; 170: 467
- Resection of upper aerodigestive tract for locally invasive thyroid cancer.Am J Surg. 1994; 168: 636
- Surgical treatment of advanced thyroid carcinoma invading the trachea.J Thorac Cardiovasc Surg. 1991; 102: 717
- Treatment of patients with carcinoma of the thyroid invading the airway.Arch Otolaryngol Head Neck Surg. 1994; 120: 1377
- Thyroid carcinoma invading the upper aerodigestive system.Laryngoscope. 1990; 100: 824
- Papillary carcinoma of the thyroid.Cancer. 1985; 29: 99
- Atrophy of the PCA as indication of RLN palsy.AJNR Am J Neuroradiol. 1999; 20: 469
- Electromyographic studies on end-to-end anastomosis of the RLN in dogs.Laryngoscope. 1990; 100: 1009
- An experimental study on laryngeal electromyography and visual observation and various type of surgical injuries to the unilateral RLN in the neck.Laryngoscope. 1991; 101: 699
- Unilateral vocal cord paralysis.Ann Otol Rhinol Laryngol. 1955; 64: 487
- Ultimate outcome of patients with vocal cord paralysis of undetermined cause.Am Rev Tuberc Pulm Dis. 1956; 73: 52
- Benign disease of the thyroid gland in vocal cord paralysis.Laryngoscope. 1974; 84: 897
- Surgical anatomy of the recurrent nerve.in: Randolph G.W. Surgery of the thyroid and parathyroid glands. Saunders, Philadelphia2003: 300-342
- Management of the recurrent laryngeal nerve in suspected and proven thyroid cancer.Otolaryngol Head Neck Surg. 1995; 113: 42
- Preservation of the recurrent laryngeal nerve invaded by differentiated thyroid cancer.Ann Surg. 1997; 226: 85-91
- Initial results from a prospective cohort study of 5,583 cases of thyroid cancer treated in the US during 1996. ACS Commission on Cancer Patient Case Evaluation Study.Cancer. 2000; 89: 202
- Invasive disease.in: Randolph G.W. Surgery of the thyroid and parathyroid glands. Saunders, Philadelphia2003: 350-365
- Resectional management of thyroid carcinoma invading the airway.Ann Thorac Surg. 1992; 54: 3
- AACE/AAES medical/surgical guidelines for clinical practice.Endocrine Practice. 2002; 7: 202-220
Surgical treatment of disease of the thyroid gland. 2.2 thyroid malignancy. Available at: www.baes.info.
- Thyroid carcinoma V1. 2005 (Available at: www.nccn.org.)
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.