Randolph and Camani offer an interesting manuscript describing a large surgical experience from Massachusetts Eye and Ear Infirmary in Boston. The authors review their observations of patients presenting with vocal cord paralysis in relation to extrathyroidal invasive malignancy. Of the 365 patients who underwent thyroidectomy, 21 had invasive thyroid malignancy. I completely agree with the authors’ observations that preoperative recurrent laryngeal nerve paralysis is a robust marker for invasive thyroid malignancy. However, recurrent laryngeal nerve paralysis is a rare event in benign disease, even with the largest of goiters. An enlarged goiter causing considerable displacement of the trachea and rotation of the larynx can lead the observer to conclude erroneously that vocal cord mobility is compromised as a result of paralysis. If vocal cord paralysis is found in benign disease, the patient is most likely to have Hashimoto’s thyroiditis or subacute thyroiditis.
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© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.