Warning: Picture of blood from a surgery depicted below. Viewer discretion is advised.
From nodules to cancer, we complete our thyroid story by looking at two of the most common post-operative complications after thyroidectomy. Affecting a small number of our thyroid surgery patients, either vocal cord paralysis or parathyroid dysfunction can cause temporary or permanent health problems.
Image Source: Dr. Barry Slaven
The vocal cords are folds of mucous membrane that stretch across the larynx and vibrate to create sound and speech. Underneath the thyroid gland lies the two recurrent laryngeal nerves, which control the movement of the vocal cords. In a thyroidectomy, the vocal cords may be injured when blood vessels, such as the inferior thyroid artery, are tied off from the vocal cords. Located in the same area, damage to one of the nerves results in a hoarse, raspy voice, while bilateral damage causes the vocal cords to become fixed in a position that obstructs airflow to the lungs. In such an event, an emergency tracheostomy may be necessary, in which the surgeon creates a hole for breathing.
The parathyroids are four small endocrine glands located on top on the thyroid glands that control the production of parathyroid hormone, which is used in bone calcium regulation. In modern thyroidectomies, the parathyroids are generally spared and carefully excised. Hypoparathyroidism occurs when all four parathyroids have been damaged, resulting in low calcium levels in the blood and causing tetany, the cramping or twitching of muscles. If this occurs, patients may require daily calcium supplements or parathyroid hormone analogs. However, as long as there is one uninjured parathyroid, patients produce enough parathyroid hormone for daily bodily functions.
Despite the long-term consequences of thyroidectomies, complications and post-operative problems occur in only 1-4% of all patients. As head and neck surgeons, most ear-nose-throat doctors take the utmost care to preserve endocrine and nerve functions. Nonetheless, collateral damage may be inevitable if the cancer spreads to surrounding tissue.
Wrapping up our trio of thyroid-related fun, the takeaway is to not ignore your body and to share any concerns with your primary care doctor. It may be the difference between an early diagnosis and protracted treatment.
Feature Image Source: Justin Chin
