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

Abstract

Purpose The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. Methods A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (<25 gr, 26–50 gr, 51–75 gr, >75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. Results In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p < 0.05), similarly occurred for the Gerd-Q (4/40 vs 1/40) (p < 0.05). Three months after TT the voice, swallowing and respiratory scores were significantly lower than the preoperative ones (p < 0.05). The SIS correlated positively with EAT-10 and RSI. After 3 months the postoperative score gain of voice, swallowing, respiratory, and reflux symptoms (Gerd-Q) was statistically higher (p < 0.05) in the cases with heaviest gland. Conclusions The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.

Post‐thyroidectomy voice and swallowing disorders and association with laryngopharyngeal reflux: A scoping review

“…15,17,21 The rest of the authors included both benign and malignant lesions. 14,[18][19][20]22,23 3.1 | Swallowing and voice outcomes…”

“…The swallowing impairment score and the eating assessment tool‐10 were both subjective outcomes used in studies 15,17,20 . In the controlled study of Sober et al, 22 patients who underwent total or partial thyroidectomy reported higher swallowing impairment score than healthy individuals.…”

“…Among inclusion bias, some authors did not exclude patients with postthyroidectomy laryngeal nerve injury, 13 while this information was not provided in three studies 14,18,21 . The rest of authors excluded patients with laryngeal nerve injuries 15–17,19,20,22,23 . The selection of patients regarding the thyroid features is another inclusion bias.…”

“…A total of 122 articles were identified and 13 papers met our inclusion criteria (Figure 1 ). 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Among them, two studies did not investigate the association between PVSS and reflux and were excluded. 4 , 24 One study focused on stomach physiology throughout the thyroidectomy.…”

“…The mean age ranged from 41 to 58 years old. Authors included patients who benefited from total thyroidectomy, 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 or both partial and total thyroidectomy. 16 , 22 , 23 The indications of thyroidectomy are reported in Table 1 .…”