Original Research Article| Volume 225, ISSUE 4, P685-689, April 2023

Longitudinal experience of patients with post-thyroidectomy vocal cord paralysis

Published:October 07, 2022DOI:


      • Routine postoperative patients and those with vocal cord paralysis both report voice symptoms immediately post thyroidectomy.
      • Patients with postoperative vocal cord paralysis have significant morbidity based on objective measures.
      • The majority of patients with vocal cord paralysis recover to baseline function, subjectively and objectively, by 6 months.



      Prior studies of post-thyroidectomy vocal cord paralysis (VCP) present static and limited evaluations. We comprehensively assessed the experience of patients with VCP post-thyroidectomy over 1 year.


      Voice Handicap Index (VHI), Eating Assessment Tool (EAT-10), 12-Item Short Form Survey (SF-12), and qualitative interviews were assessed preoperatively, and 2-weeks, 6-weeks, 6-months, and 1-year postoperatively.


      7 of 44 patients (15.9%) had postoperative VCP. Compared to those without complication, mean VHI scores for VCP patients increased significantly from baseline at 2-weeks (27.9 point increase vs 1.6, p < 0.01) and 6-weeks (26.3 vs. −0.3, p < 0.01) postoperative. There were no significant differences between groups in SF-12 or EAT-10 scores at any point. Qualitative interviews showed that both groups noted bothersome voice symptoms at 2-weeks; however, by 6-weeks, only VCP patients noted voice symptoms negatively affecting their life.


      While both patients with and without VCP reported subjective voice symptoms immediately postoperatively, those with VCP had worse quantitative measures. Understanding the longitudinal experience of VCP can help providers tailor counseling for these patients.
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        • Hayward N.J.
        • Grodski S.
        • Yeung M.
        • Johnson W.R.
        • Serpell J.
        Recurrent laryngeal nerve injury in thyroid surgery: a review.
        ANZ J Surg. 2013; 83: 15-21
        • Francis D.O.
        • Sherman A.E.
        • Hovis K.L.
        • et al.
        Life experience of patients with unilateral vocal fold paralysis.
        JAMA Otolaryngol Head Neck Surg. 2018; 144: 433-439
        • Jeannon J.P.
        • Orabi A.A.
        • Bruch G.A.
        • Abdalsalam H.A.
        • Simo R.
        Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review.
        Int J Clin Pract. 2009; 63: 624-629
        • Bhattacharyya N.
        • Fried M.P.
        Assessment of the morbidity and complications of total thyroidectomy.
        Arch Otolaryngol Head Neck Surg. 2002; 128: 389-392
        • Francis D.O.
        • Pearce E.C.
        • Ni S.
        • Garrett C.G.
        • Penson D.F.
        Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population.
        Otolaryngol Head Neck Surg. 2014; 150: 548-557
        • Joliat G.-R.
        • Guarnero V.
        • Demartines N.
        • Schweizer V.
        • Matter M.
        Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: incidence and postoperative evolution assessment.
        Medicine (Baltim). 2017; 96 (e6674): e6674
        • Sun G.H.
        • DeMonner S.
        • Davis M.M.
        Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.
        Thyroid. 2013; 23: 727-733
        • Ho T.W.T.
        • Shaheen A.A.
        • Dixon E.
        • Harvey A.
        Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study.
        Am J Surg. 2011; 201: 570-574
        • Toumi A.
        • DiGennaro C.
        • Vahdat V.
        • et al.
        Trends in thyroid surgery and guideline-concordant care in the United States, 2007-2018.
        Thyroid. 2021; 31: 941-949
        • Fang T.-J.
        • Li H.-Y.
        • Gliklich R.E.
        • Chen Y.-H.
        • Wang P.-C.
        • Chuang H.-F.
        Quality of life measures and predictors for adults with unilateral vocal cord paralysis.
        Laryngoscope. 2008; 118: 1837-1841
        • Gartling G.J.
        • van Mersbergen M.
        • Crow K.
        • Lewandowski A.
        • Smith L.J.
        • Gartner-Schmidt J.L.
        The patient experience: the relationship between vocal Handicap, congruency, perceived present control, and mood across four voice disorders.
        J Voice. 2021;
        • Spector B.C.
        • Netterville J.L.
        • Billante C.
        • Clary J.
        • Reinisch L.
        • Smith T.L.
        Quality-of-life assessment in patients with unilateral vocal cord paralysis.
        Otolaryngol Head Neck Surg. 2001; 125: 176-182
        • Gohrbandt A.E.
        • Aschoff A.
        • Gohrbandt B.
        • Keilmann A.
        • Lang H.
        • Musholt T.J.
        Changes of laryngeal mobility and symptoms following thyroid surgery: 6-month follow-up.
        World J Surg. 2016; 40: 636-643
        • Maeda T.
        • Saito M.
        • Otsuki N.
        • et al.
        Voice quality after surgical treatment for thyroid cancer.
        Thyroid. 2013; 23: 847-853
        • Wilson J.A.
        • Deary I.J.
        • Millar A.
        • Mackenzie K.
        The quality of life impact of dysphonia.
        Clin Otolaryngol Allied Sci. 2002; 27: 179-182
        • Sippel R.S.
        • Robbins S.E.
        • Poehls J.L.
        • et al.
        A randomized controlled clinical trial: No clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer.
        Ann Surg. 2020; 272: 496-503
        • Jacobson B.H.
        • Johnson A.
        • Grywalski C.
        • et al.
        The voice Handicap Index (VHI).
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Belafsky P.C.
        • Mouadeb D.A.
        • Rees C.J.
        • et al.
        Validity and reliability of the eating assessment Tool (EAT-10).
        Ann Otol Rhinol Laryngol. 2008; 117: 919-924
        • Ware J.
        • Ma K.
        • Keller S.D.
        SF-36 physical and mental Health summary scales.
        a User's Manual. 1993; 8: 23-28
        • Hjermstad M.J.
        • Fossa S.D.
        • Bjordal K.
        • Kaasa S.
        Test/retest study of the European organization for research and treatment of cancer core quality-of-life questionnaire.
        J Clin Oncol. 1995; 13: 1249-1254
        • Sinagra D.L.
        • Montesinos M.R.
        • Tacchi V.A.
        • et al.
        Voice changes after thyroidectomy without recurrent laryngeal nerve injury.
        J Am Coll Surg. 2004; 199: 556-560
        • Myers E.N.
        • Hong K.H.
        • Kim Y.K.
        Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury.
        Otolaryngology-Head Neck Surg (Tokyo). 1997; 117: 399-404
        • D'Alatri L.
        • Galla S.
        • Rigante M.
        • Antonelli O.
        • Buldrini S.
        • Marchese M.R.
        Role of early voice therapy in patients affected by unilateral vocal fold paralysis.
        J Laryngol Otol. 2008; 122: 936-941
        • Alghonaim Y.
        • Roskies M.
        • Kost K.
        • Young J.
        Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty.
        J Otolaryngol - Head & Neck Surg. 2013; 42: 24
        • Lombardi C.P.
        • Raffaelli M.
        • D'Alatri L.
        • et al.
        Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.
        Surgery. 2006; 140 (discussion 1032-1024): 1026-1032
        • Francis D.O.
        • McKiever M.E.
        • Garrett C.G.
        • Jacobson B.
        • Penson D.F.
        Assessment of patient experience with unilateral vocal fold immobility: a preliminary study.
        J Voice. 2014; 28: 636-643