Voice and throat dysfunction may occur in patients after thyroidectomy, even in the absence of apparent laryngeal nerve injury. We evaluated the impact of thyroid surgery on voice and throat function using perceptive, objective, and subjective measurements in a prospectively enrolled and serially followed cohort of thyroid cancer patients. We assessed the impact of surgical extent and intensity of postoperative treatment, including addition radioactive iodine treatment (RIT), on these functions.
Consenting patients undergoing thyroid lobectomy (TL; n = 33), total thyroidectomy (TT; n = 41), or TT plus RIT (n = 81), none of whom had laryngeal nerve dysfunction perioperatively, were enrolled prospectively. All underwent comprehensive functional evaluations, including perceptive voice quality using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale and acoustic voice analysis with multiple parameters, and filled out subjective questionnaires, including the Voice Handicap Index (VHI) and the Glasgow Edinburgh Throat Scale, before thyroidectomy and at 1, 6, and 12 months postoperatively.
In this study, 14–83% of the patients developed some element of voice and throat dysfunction, shown consistently in different evaluations. Typical patterns were alterations of perceptive voice, deranged acoustic parameters, and subjective worsening on the VHI and GETS. Moreover, these changes were correlated with the extent of treatment, especially within 3 months after operation, and often persisted 12 months postoperatively. RIT had no effects on voice outcomes throughout the follow-up.
Voice and throat dysfunction are evident after thyroidectomy, more severely after TT than TL. These potential disabilities should be considered carefully to further enhance patients' quality of life.
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- Cancer facts & figures, National Cancer Registry data in Korea.Ministry of Health and Welfare & National Cancer Center, Korea2011
- Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis.Cancer. 2007; 110: 1451-1456
- Differentiated thyroid cancer presenting initially with distant metastasis.Am J Surg. 1997; 174: 474-476
- Assessment of the morbidity and complications of total thyroidectomy.Arch Otolaryngol Head Neck Surg. 2002; 128: 389-392
- Thyroidectomy and the recurrent laryngeal nerves.Lancet. 1956; 270: 988-990
- Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy.Surgery. 2003; 133: 318-322
- Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.Surgery. 2006; 140: 1026-1032
- The functional impact on voice of sternothyroid muscle division during thyroidectomy.Ann Surg Oncol. 2008; 15: 2027-2033
- Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms.Surgery. 2009; 146: 1174-1181
- Prospective functional voice assessment in patients undergoing thyroid surgery.Ann Surg. 2002; 236: 823-832
- Voice changes after thyroidectomy without recurrent laryngeal nerve injury.J Am Coll Surg. 2004; 199: 556-560
- Post-thyroidectomy superior laryngeal nerve injury.Eur Arch Otorhinolaryngol. 2001; 258: 451-454
- Thyroid surgery and voice-related outcomes.Aust N Z J Surg. 2000; 70: 179-183
- Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.Thyroid. 2009; 19: 1167-1214
- Development and validation of the voice handicap index-10.Laryngoscope. 2004; 114: 1549-1556
- Voice handicap index change following treatment of voice disorders.J Voice. 2000; 14: 619-623
- Globus pharyngis: development of a symptom assessment scale.J Psychosom Res. 1995; 39: 203-213
- Preoperative pulmonary function testing to predict postoperative morbidity and mortality.Chest. 1986; 89: 127-135
- Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury.Otolaryngol Head Neck Surg. 1997; 117: 399-404
- Acoustic analysis of the speaking voice after thyroidectomy.J Voice. 1997; 11: 479-482
- Local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngopharyngitis.Eur Arch Otorhinolaryngol. 2011; 268: 715-720
- Acute effects of radioiodine therapy on the voice and larynx of Basedow-Graves patients.Braz J Otorhinolaryngol. 2008; 74: 224-229
Published online: August 12, 2013
Accepted: March 28, 2013
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.