Should You Undergo Laryngoscopy for Thyroid Cancer Symptoms?

Should a laryngoscopy be performed, or can it be avoided?

Symptoms: Hello, Doctor! The patient is a woman in her 60s.
She recently underwent surgery for thyroid cancer about two months ago, but has suddenly developed a small swelling on the surface of her chest.
A chest CT scan showed no issues, but there is a mass in the laryngeal cartilage.
One doctor advised that she needs to be hospitalized for general anesthesia and biopsy to establish a diagnosis quickly; another doctor suggested that a follow-up every six months would suffice and that a biopsy is unnecessary.
Additionally, there are some conditions I forgot to mention last time: about a month ago, during root canal treatment, she experienced cellulitis, which had never occurred before (it has since resolved, but she still often has tooth pain).
Furthermore, she sometimes experiences blurred vision, insomnia, and excessive sleepiness, feeling as if she is not getting enough rest.
Her Tg levels remain elevated (the endocrinologist believes she should continue taking I-131 after surgery).
Recently, she has experienced some shortness of breath and difficulty taking deep breaths, and she feels that her condition is worsening.
She has many questions and feels uncertain without further evaluation.
Is it necessary for her to undergo general anesthesia for the biopsy? Is local anesthesia an option? Are there any risks, and can her body tolerate it? Duration: Initially, there was a white spot in the cavity.
On the other side, there is redness and inflammation, which has gradually deepened.
Additionally, her throat has been frequently dry, and her voice has become increasingly hoarse over the past three months.
Supplementary information: She had breast cancer surgery two years ago and thyroid cancer surgery four months ago.
Thank you, Doctor, for your professional opinion!

MICES, 20~29 year old female. Ask Date: 2002/11/22

Dr. Zeng Yuhua reply Oncology

Hello! The patient has two types of cancer, and if an abnormal new tumor is found, it is advisable to perform a biopsy for examination if there are any suspicions.
Whether to use regional or general anesthesia should be discussed with an anesthesiologist.
Additionally, the patient is experiencing poor mental status and has a swollen appearance; it may be beneficial to check thyroid hormone levels to see if they are low.
The oral condition appears to resemble an oral ulcer, which is common in cancer patients or those with compromised immune systems.
The hoarseness of voice may be related to a mass affecting the cricoid cartilage or poor vocal cord mobility, and an evaluation by an ENT specialist is recommended.
Best wishes for health from Dr.
Tseng Yu-Hua, Department of Health, Taoyuan.

Reply Date: 2002/11/22

More Info

Laryngoscopy is a procedure that allows doctors to examine the larynx (voice box) and surrounding areas. In the context of thyroid cancer, especially when there are concerning symptoms such as a mass in the area of the larynx or changes in voice, laryngoscopy can be an important diagnostic tool. The decision to undergo this procedure, particularly under general anesthesia, depends on several factors, including the patient's overall health, the specific symptoms being experienced, and the findings from previous examinations.

In your case, the patient is a woman in her 60s who has undergone surgery for thyroid cancer and is now presenting with a mass in the area of the larynx, along with other symptoms such as hoarseness, dry throat, and a history of dental issues. Given her medical history and the potential for complications related to thyroid cancer, it is understandable that one doctor would recommend a laryngoscopy under general anesthesia to ensure a thorough examination and biopsy if necessary. This approach allows for a more comprehensive evaluation of the laryngeal structures and any potential malignancies.

On the other hand, the second doctor’s recommendation for follow-up every six months without immediate intervention may be based on the current stability of the patient's condition and the results from previous imaging studies, such as the chest CT scan that showed no abnormalities. This conservative approach may be appropriate if the mass is not causing significant symptoms or if there is a low suspicion of malignancy.

Regarding anesthesia, laryngoscopy can often be performed under local anesthesia, especially if the procedure is expected to be brief and the patient is stable. Local anesthesia can minimize risks associated with general anesthesia, such as respiratory complications, especially in patients with underlying health issues. However, if the procedure is expected to be more invasive or if the patient is particularly anxious, general anesthesia may be preferred to ensure comfort and cooperation during the examination.

The risks associated with undergoing laryngoscopy under general anesthesia include potential respiratory complications, adverse reactions to anesthetic agents, and the need for monitoring during the procedure. The patient's overall health, including any history of respiratory issues or other comorbidities, should be carefully evaluated by an anesthesiologist prior to the procedure.

In terms of duration, laryngoscopy is typically a short procedure, often lasting less than an hour. However, the total time spent in the operating room will include preparation and recovery time, especially if general anesthesia is used.

Given the complexity of the patient's symptoms and medical history, it is crucial to have a thorough discussion with the healthcare team, including an ENT specialist and an anesthesiologist, to weigh the benefits and risks of the procedure. If there are concerns about the mass in the larynx, obtaining a definitive diagnosis through laryngoscopy may be necessary to guide further treatment, especially in the context of her previous thyroid cancer.

In conclusion, while general anesthesia may not be strictly necessary for laryngoscopy, it may be warranted based on the patient's specific circumstances and the complexity of the examination required. A collaborative approach involving the patient, her family, and her healthcare providers will help ensure that the best decision is made regarding her care.

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