How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Abstract

Swallowing, voice disorders, throat discomfort and subjective neck discomfort are usually reported by patients with a known thyroid nodule and are correlated to nodular thyroid disease itself. Moreover, in endemic goitrous areas, total thyroidectomy (TT) is the most frequently performed surgical procedure. We are used to relate swallowing, voice and throat discomfort to the mechanical effects of nodular goiter or to thyroidectomy itself, but in both these cases the relationship between symptoms and the thyroid mass or its removal is not always clear or easily demonstrated. How can we explain the persistence of local neck symptoms after TT? And how can TT worsen the dysphagic or dysphonic disorders attributed to the goiter's effect over the surrounding structures? During these years, many articles have analyzed the relationship between the thyroid disease and the laryngopharyngeal reflux, finding more and more evidences of their consensuality, leading to important new management considerations and notable medico-legal implications; if the reason of local neck symptoms is not the thyroid disease, we have to study and specially cure the reflux disease, with specific test and drugs. Therefore, the aim of our study, relying on the published literature, was to investigate how, in demonstrated presence of reflux laryngopharyngitis in patients with nodular goiter and local neck symptoms before and after uncomplicated TT, the surgery could influence our anti-reflux mechanism analyzing the anatomical connection as well as the functional coordination; can we play a part in the post-operative persistence of swallowing and voice alterations and throat discomfort?

Aggravation of Reflux Finding Score (RFS) after thyroidectomy

“…It has been suggested that laryngopharyngeal reflux (LPR) also plays a role in patients with post-thyroidectomy syndrome [7,8]. LPR is a retrograde flow of gastric and duodenal contents into the pharynx or larynx above the upper esophageal sphincter (UES).…”

Thyroidectomy-related Swallowing Difficulties: Review of the Literature

“…Authors who have compared conventional open thyroidectomy to robotic techniques, minimally invasive thyroid surgery, and subfascial approach to the thyroid reported a statistically significant increase of swallowing impairments in the conventional group ( 10 , 11 , 16 , 33 , 37 , 38 , 52 , 53 ). Additionally, laryngopharyngeal reflux (LPR) could influence postsurgical swallowing complaints ( 6 , 13 , 25 , 54 , 55 ).…”

Neck complaints before and after uncomplicated thyroidectomy: prevalence, postoperative outcome and relationships with thyroid weight and reflux like symptoms

“…Similarly results were observed for dysphagia except for patients who underwent videoassisted TT (symptoms ameliorated already 1 month after TT). Cusimano et al [26] studied patients Fig. 3 The late postoperative mean scores stratified by groups of thyroid weight.…”

“…Similarly results were observed for dysphagia except for patients who underwent videoassisted TT (symptoms ameliorated already 1 month after TT). Cusimano et al [ 26 ] studied patients affected by reflux to explain the role of thyroidectomy in persistent neck symptoms. The authors speculated that surgery may worsen the reflux disease by reducing antireflux systems and suggests including reflux disease as cause for neck postoperative discomforts.…”