The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease
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Jesper Roed Sorensen, PhD, Trine Printz, MA, Jenny Iwarsson, PhD, Ågot Møller Grøntved, MD, Helle Døssing, PhD, Laszlo Hegedüs, Steen Joop Bonnema, Christian Godballe, Camilla Slot Mehlum, MD First Published June 11, 2019 Research Article
https://doi.org/10.1177/0194599819855379
Article information
No Access
Abstract
Objective
To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease.
Study Design
Observational study.
Setting
University hospital.
Subjects and Methods
Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen’s effect size was used to evaluate changes.
Results
Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI (P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency (P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT (P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point (P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery.
Conclusion
Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.
Keywords thyroidectomy, goiter, recurrent laryngeal nerve, external branch of the superior laryngeal nerve, voice, quality of life
Show less
Jesper Roed Sorensen, PhD, Trine Printz, MA, Jenny Iwarsson, PhD, Ågot Møller Grøntved, MD, Helle Døssing, PhD, Laszlo Hegedüs, Steen Joop Bonnema, Christian Godballe, Camilla Slot Mehlum, MD First Published June 11, 2019 Research Article
https://doi.org/10.1177/0194599819855379
Article information
No Access
Abstract
Objective
To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease.
Study Design
Observational study.
Setting
University hospital.
Subjects and Methods
Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen’s effect size was used to evaluate changes.
Results
Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI (P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency (P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT (P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point (P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery.
Conclusion
Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.
Keywords thyroidectomy, goiter, recurrent laryngeal nerve, external branch of the superior laryngeal nerve, voice, quality of life
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