Clin Exp Otorhinolaryngol.  2015 Mar;8(1):76-80. 10.3342/ceo.2015.8.1.76.

Does Postthyroidectomy Syndrome Really Exist Following Thyroidectomy? Prospective Comparative Analysis of Open vs. Endoscopic Thyroidectomy

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. lsw0922@schmc.ac.kr
  • 2Division of Endocrinology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Abstract


OBJECTIVES
This study prospectively evaluated postthyroidectomy syndrome (PTS) through objective and subjective voice changes following thyroidectomy of open vs. endoscopic thyroidectomy.
METHODS
A prospective clinical trial (SCHBC IRB 09 26) was performed from Jan 2008 to Aug 2010 to compare the open thyroidectomy (OPEN group) and endoscopic thyroidectomy (ENDO group). Of the 110 patients, 75 completed the evaluation before and 1 and 6 months after surgery. Subjective parameters included perceptual analysis (GRBAS [grade, roughness, breathiness, asthenia, and strain] scale), stroboscopic or flexible fiberscopic analysis, voice handicap index, and 5-point visual analog scales for vocal fatigue, singing difficulty, difficulty with high-pitch phonation, and neck discomfort. Objective parameters included acoustic, aerodynamic analysis and the electroglottograph.
RESULTS
For the ENDO group (n=36), the operation time was longer than in the OPEN group (n=39; P<0.01). For the OPEN group, two objective and five subjective parameters were worse 1 month postoperatively; of these, two subjective parameters persisted for 6 months (P<0.05). For the ENDO group, three objective and six subjective parameters were worse 1 month postoperatively, and three of the subjective parameters persisted 6 months postoperatively (P<0.05).
CONCLUSION
PTS really exists following simple thyroidectomy and are very common for both OPEN and ENDO groups. Most of the parameters improved gradually over time, but some subjective changes persisted 6 months postoperatively.

Keyword

Thyroidectomy; Voice Quality; Postoperative Complications

MeSH Terms

Acoustics
Asthenia
Ethics Committees, Research
Fatigue
Humans
Neck
Phonation
Postoperative Complications
Prospective Studies*
Singing
Thyroidectomy*
Visual Analog Scale
Voice
Voice Quality

Figure

  • Fig. 1 The position of patient during endoscopic total thyroidectomy+ ipsilateral central neck dissection through a unilateral transaxillary approach.

  • Fig. 2 Changes in the objective parameters during follow-up in the conventional open thyroidectomy group. PreOp, preoperatively; Post 1M, 1 month postoperatively; Post 6M, 6 months postoperatively; MPT, maximum phonation time (second); Max/Mean/Min F0/20, maximum/mean/minimum fundamental frequency/20; HNR/10, harmonics-to-noise ratio (dB)/10; CQ/10, contact quotient (%) of the electroglottograph/10. *P<0.05, using paired t-test, PreOp vs. Post 1M.

  • Fig. 3 Changes in the subjective parameters during follow-up in the conventional open thyroidectomy group. PreOp, preoperatively; Post 1M, 1 month postoperatively; Post 6M, 6 months postoperatively; GRBAS, grade, roughness, breathiness, asthenia, and strain; GRBAS, sum of the GRBAS scale; VHI, voice handicap index; Vocal fatigue, visual analog scale of the patients' symptomatic rating of vocal fatigue; Singing, visual analog scale of the patients' symptomatic rating of the singing difficulty; High pitch, visual analog scale of the patients' symptomatic rating of the high-pitched voice difficulty; Neck discomfort, visual analog scale of the patients' symptomatic rating of neck discomfort. *,†P<0.05, using paired t-test. *PreOp vs. Post 1M. †PreOp vs. Post 6M.

  • Fig. 4 Changes in the objective parameters during follow-up in the endoscopic thyroidectomy group. PreOp, preoperatively; Post 1M, 1 month postoperatively; Post 6M, 6 months postoperatively; MPT, maximum phonation time (second); Max/Mean/Min F0/20, maximum/mean/minimum fundamental frequency/20; HNR/10, harmonics-to-noise ratio (dB)/10; CQ/10, contact quotient (%) of the electroglottograph/10. *P<0.05, using paired t-test. PreOp vs. Post 1M.

  • Fig. 5 Changes in the subjective parameters during follow-up in the endoscopic thyroidectomy group. PreOp, preoperatively; Post 1M, 1 month postoperatively; Post 6M, 6 months postoperatively; GRBAS, grade, roughness, breathiness, asthenia, and strain; GRBAS, sum of the GRBAS scale; VHI, voice handicap index; Vocal fatigue, visual analog scale of the patients' symptomatic rating of vocal fatigue; Singing, visual analog scale of the patients' symptomatic rating of the singing difficulty; High pitch, visual analog scale of the patients' symptomatic rating of the high-pitched voice difficulty; Neck discomfort, visual analog scale of the patients' symptomatic rating of neck discomfort. *,†P<0.05, using paired t-test. *PreOp vs. Post 1M. †PreOp vs. Post 6M.


Reference

1. Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg. 2004; 10. 199(4):556–560. PMID: 15454138.
Article
2. Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol. 2001; 11. 258(9):451–454. PMID: 11769989.
Article
3. Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg. 2002; 12. 236(6):823–832. PMID: 12454521.
Article
4. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg. 1997; 10. 117(4):399–404. PMID: 9339803.
Article
5. Koh YW, Park JH, Lee SW, Choi EC. The harmonic scalpel technique without supplementary ligation in total thyroidectomy with central neck dissection: a prospective randomized study. Ann Surg. 2008; 6. 247(6):945–949. PMID: 18520221.
6. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel. Surg Endosc. 2010; 5. 24(5):1117–1125. PMID: 19997752.
Article
7. Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay MJ, Coppit GL, et al. Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia. Surgery. 2008; 6. 143(6):732–742. PMID: 18549889.
Article
8. McIvor NP, Flint DJ, Gillibrand J, Morton RP. Thyroid surgery and voice-related outcomes. Aust N Z J Surg. 2000; 3. 70(3):179–183. PMID: 10765899.
Article
9. Hong KH, Ye M, Kim YM, Kevorkian KF, Berke GS. The role of strap muscles in phonation--in vivo canine laryngeal model. J Voice. 1997; 3. 11(1):23–32. PMID: 9075173.
10. de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, et al. Voice and vocal self-assessment after thyroidectomy. Head Neck. 2006; 12. 28(12):1106–1114. PMID: 16933312.
Article
11. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Surg Endosc. 2010; 1. 24(1):188–197. PMID: 19688395.
Article
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