Hypothyroidism is not commonly considered a complication of radiotherapy for head and neck cancer. A series of 96 patients treated with radiotherapy alone or combined with surgery for head and neck cancer was retrospectively studied. All patients had radiation ports that included the thyroid gland. Hypothyroidism after radiotherapy was documented in 26% of all patients. The majority of patients had subclinical hypothyroidism manifested by elevated thyroid-stimulating hormone (TSH) levels. The incidence of hypothyroidism dramatically increased to 65% when radiotherapy was combined with surgery that included a partial thyroidectomy. In addition, we report the unusual occurrence of massive head, neck, and hypopharyngeal edema caused by severe hypothyroidism in two patients. We advocate routine monitoring of head and neck cancer patients for hypothyroidism after radiotherapy involving the thyroid gland and recommend levothyroxine replacement therapy for subclinical hypothyroidism.

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Hereditary forms of carcinoma may be associated with benign head and neck tumors. Many of these hereditary carcinoma syndromes present first to the otolaryngologist. Two unusual cases of Gardner's and Muir--Torre's syndromes illustrate the hereditary carcinoma syndromes associated with head and neck lesions. We describe the use of new genetic markers and propose a diagnostic algorithm.

The recurrent laryngeal nerve (RLN) is one of the most frequently injured nerves in head and neck surgery. Routine identification of the RLN during thyroid surgery has reduced the injury rate from 10% to less than 4%. Difficulty in identification of the RLN contributes to this surgical morbidity. Devices previously used for intraoperative identification of the RLN have failed to achieve the simplicity and reliability necessary for clinical use. This animal study uses a simple double-ballooned endotracheal tube and pressure transducer system, which assists intraoperative RLN identification through nerve stimulation and graphic documentation of vocal fold (VF) motion. Iatrogenic injury is demonstrated by a dampened stimulation-pressure tracing. The RLNs of three piglets were injured and examined, and the degree of injury was correlated with perioperative nerve stimulation patterns. The piglet proved to be an adequate model for laryngeal research. An FDA-approved multi-institutional prospective human study using this system of identification of the RLN is in progress.

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