The impact of perioperative dexamethasone on swallowing impairment score after thyroidectomy: a retrospective study of 118 total thyroidectomies

Abstract

Dear Editor, Even though more than half of patients undergoing thyroidectomy complain of non-specific dysphagia, when no laryngeal nerve injury is involved the importance of this complication is often overlooked. 1-3 Post-thyroidectomy swallowing problems include non-specific swallowing changes and discomfort, occasional dysphagia, painful swallowing, swallowing difficulty and sensation of a lump or coughing. 3,4 These symptoms usually resolve after a short period 4 but sometimes may persist long after surgery. 2 Steroids are well known for their analgesic, antiinflammatory, immune-modulating and antiemetic effects. 5 Furthermore, evidence in the literature supports the perioperative use of corticosteroids in thyroid surgery as prophylaxis for post-operative nausea and vomiting 5-7 or analgesia. 5,6 In our department, it is a common practice of some anaesthesiologist to use perioperative steroids in thyroid surgery, while some others do not; so some of our patients receive perioperative steroids and others do not. To our knowledge, the impact of steroids on swallowing symptoms after thyroidectomy has never been evaluated so far (PubMed search).The purpose of this study was to evaluate the impact of a single perioperative dexamethasone administration on postthyroidectomy swallowing symptoms as expressed by swallowing impairment score (SIS-6) questionnaire. 8 Methods Ethical considerationsCase notes and computer data only were used for this study complying with the regulations of University Hospital of Larissa scientific committee. This study was approved by the University Hospital of Larissa review board. Participants and outcome measures

Thyroidectomy-related Swallowing Difficulties: Review of the Literature

“…The types of studies included in the review were: 29 prospective cohort studies ( 4 - 6 , 8 - 33 ),7 case-control studies ( 34 - 39 ), 3 retrospective studies ( 7 , 40 - 42 ), and 2 cross-sectional studies ( 43 , 44 ).…”

“…The Swallowing Impairment Index (SIS-6) was the most-used questionnaire among the reviewed studies (14 studies) ( 5 , 6 , 8 , 11 , 16 - 18 , 25 , 33 , 38 , 40 , 53 , 56 ). It is a specifically designed questionnaire self-evaluation that, with simple statements, addresses the spectrum of symptoms typically reported by patients.…”

“…Fiberoptic laryngoscopy represents a standard diagnostic procedure that all patients scheduled for thyroid surgery should undergo prior to surgical treatment as well as postoperatively. It is primarily performed in order to identify changes in vocal fold mobility and to differentiate patients with laryngeal nerve damage ( 4 , 6 , 8 , 10 , 11 , 13 , 14 , 16 - 19 , 23 , 24 , 31 , 35 , 37 , 38 , 40 , 41 ). Although it does not provide information on swallowing impairment, swelling of laryngeal mucosa, especially in the posterior part of the larynx and retrocricoid area, can indirectly indicate laryngopharyngeal reflux, whereas saliva residue in the piriform sinuses or retrocricoid area can indicate dysfunction of the upper esophageal sphincter ( 67 ).…”

Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy

“…Dexamethasone is also effective at treating swallowing impairment, nausea, and vomiting after thyroidectomy. [ 24 , 25 ] Given voice preservation is a major outcome measure after thyroidectomy, we conducted a metaanalysis to the effect of dexamethasone injection on voice quality.…”

Betamethasone to Prevent Symptomatic Hypocalcaemia and Other Complications after Total Thyroidectomy: a Case-control Study

“…HC is common in the immediate postoperative period, with a reported incidence of 27% (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) in the literature; however, permanent HC is rare, with an incidence of 1% (0-3) (1). HC is a major cause of prolonged postoperative recovery and hospital care costs (2).…”