Epidemiology of Vocal Fold Paralyses after Total Thyroidectomy for Well‐Differentiated Thyroid Cancer in a Medicare Population

Abstract

Objectives Population-level incidence of vocal fold paralysis after thyroidectomy for well-differentiated thyroid carcinoma (WDTC) is not known. This study aimed to measure longitudinal incidence of post-operative vocal fold paralyses and need for directed interventions in the Medicare population undergoing total thyroidectomy for WDTC. Study Design Retrospective Cohort Study Setting United States Population Subjects Medicare Beneficiaries Methods SEER-Medicare data (1991 – 2009) were used to identify beneficiaries who underwent total thyroidectomy for WDTC. Incident vocal fold paralyses and directed interventions were identified. Multivariate analyses were used to determine factors associated with odds of developing these surgical complications. Results Of 5,670 total thyroidectomies for WDTC, 9.5% were complicated by vocal fold paralysis [8.2% unilateral vocal fold paralysis (UVFP); 1.3% bilateral vocal fold paralysis (BVFP)]. Rate of paralyses decreased 5% annually from 1991 to 2009 (OR 0.95, 95% CI 0.93 – 0.97; p<0.001). Overall, 22% of patients with vocal fold paralysis required surgical intervention (UVFP 21%, BVFP 28%). Multivariate logistic regression revealed odds of post-thyroidectomy paralysis increased with each additional year of age, with non-Caucasian race, particular histologic types, advanced stage, and in particular registry regions. Conclusions Annual rates of post-thyroidectomy vocal fold paralyses are decreasing among Medicare beneficiaries with WDTC. High incidence in this aged population is likely due to a preponderance of temporary paralyses, which is supported by the need for directed intervention in less than a quarter of affected patients. Further population-based studies are needed to refine the population incidence and risk factors for paralyses in the aging population.

Sintomas sensoriais em pacientes submetidos à tireoidectomia

“…The manipulation and/or injury of the vagus nerve can importantly impact function and the quality of life of patients, considering that they can evolve with motor and sensorial alterations such as reduction/absence of laryngeal sensitivity, modulation restriction of the acute frequency, and compromised vocal fold mobility (2) . In thyroidectomy, surgical manipulation accounts for respectively 46% and 56% of the cases of unilateral and bilateral vocal fold paralysis, which often result in severe dysphonia, dysphagia and dyspnea (14,15) . Therefore, it is important to document laryngeal evaluation before and after thyroidectomy due to the potential impact that may be caused by thyroidectomy (16) and orient the patient preoperatively with respect to the possible sequels of surgery (17) .…”

Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model

“…In addition, it is also helpful to predict the outcome of vocal cord function during the operation . However, RLN surgical injury and postoperative vocal cord paralysis still occurs in approximately 9% of patients undergoing thyroidectomy …”

Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis

“…Results must be considered in context of the inherent limitations of its retrospective cohort study design. Moreover, any study showing change in vocal fold functional recovery can be confounded by a baseline and spontaneous recovery rate, which is exemplified by the transience of UVFP after many surgical procedures . Also, avoidance of framework surgery is a surrogate outcome for sufficient recovery to mitigate patient symptoms.…”

“…Most practitioners opt for injection augmentation prior to considering definitive framework operations . Large epidemiological studies indicate that over 80% of postthyroidectomy UVFP cases are transient . Recognizing the possibility of spontaneous recovery, most surgeons recommend that patients wait 6 to 12 months prior to offering framework operations .…”