Bilateral vocal cord paralysis developed following hemithyroidectomy in a patient with chronic inflammatory demyelinizing polyneuropathy

Abstract

Purpose: Nodular thyroid disease is a common pathology in adult population and most of the patients may have coexistent diseases. Chronic inflammatory demyelinizing polineuropathy (CIDP) can be one of these diseases characterized with demyelinization and remyelinization of the peripheral nerves. Symptoms occur depending on the nerve involved. The disease may rarely involve the recurrent laryngeal nerve (RLN) and cause symptomatic or subclinical vocal cord paralysis.

Results: A 47 year-old, female patient with CIDP has developed a nodule, 4 cm in diameter, in the right lobe, causing symptoms of pressure. The patient underwent right hemithyroidectomy. During the operation right RLN was identified and preserved, left lobe was palpated over the strap muscles as it was normal. Frozen section was reported as benign. The operation was completed without left side exploration. Three hours after the operation, difficulty in breathing developed and vocal cord examination indicated complete paralysis on the left and incomplete paralysis on the right side. Tracheatomy was performed. This patient hasn't had a vocal cord examination as she had no neck surgery before, but demyelinizing neurological diseases can cause vocal cord paralysis by involving RLN. We thought that left side vocal cord paralysis was not the result of the operation, but from her coexistent demyelinising disease.

Conclusion: We concluded that in these cases, preoperative vocal cord examination can be helpful in estimating and reducing postoperative complications.