Post-Thyroid Surgery Voice Issues: Causes and Recovery

Postoperative Issues After Thyroid Surgery

Hello Dr.
Hsieh,
My mother-in-law (63 years old) underwent a bilateral thyroid tumor resection three months ago; this was her second surgery.
The first surgery was 30 years ago (at age 33), after which she experienced hoarseness, but her voice returned to normal after a month.
However, since the recent surgery, her voice has remained hoarse without improvement.
An ENT specialist performed an endoscopic examination and diagnosed her with left vocal cord paralysis.
Both tumors from the two surgeries were confirmed to be benign through biopsy.
I recall that her voice was normal within a week after the second surgery, but it suddenly became hoarse after prolonged conversation.
It has not improved since.
I have a few questions:
1.
If she is diagnosed with vocal cord paralysis, why was her voice normal immediately after the surgery but became hoarse a week later?
2.
If there is edema on the vocal cords pressing on the nerve, could this cause such symptoms? Will her voice return to normal, and if so, how long might that take?
3.
If the surgery damaged the vocal cord nerve, would she experience immediate hoarseness after the surgery, or would it develop gradually?
4.
Could her hoarseness be related to excessive talking after the surgery?
Thank you.

A-Zhong, 30~39 year old female. Ask Date: 2005/07/27

Dr. Xie Wenhuai reply Surgery

Thyroid surgery typically requires general anesthesia and the insertion of an endotracheal tube, which passes through the vocal cords.
As a result, postoperative symptoms often include sore throat and hoarseness, but these usually do not last longer than 10 days and are reversible.
As you mentioned, vocal cord paralysis may occur due to nerve injury.
The symptoms present in a progressive manner and can lead to hoarseness due to incomplete closure of the vocal cords, which is irreversible.

Reply Date: 2005/07/27

More Info

Post-thyroid surgery voice issues, particularly hoarseness or vocal cord paralysis, can be concerning for patients and their families. In your mother-in-law's case, her history of thyroid surgery and the recent development of left vocal cord paralysis warrant a thorough understanding of the potential causes and recovery processes.

1. Why was her voice normal immediately after surgery but became hoarse a week later?
It is not uncommon for patients to experience transient voice changes after thyroid surgery. Initially, the voice may be normal due to the effects of anesthesia and swelling subsiding. However, as the swelling increases or if there is any trauma to the recurrent laryngeal nerve (which innervates the vocal cords), symptoms may manifest later. In your mother-in-law's case, the left vocal cord paralysis suggests that there may have been some nerve involvement during the surgery, which could have been exacerbated by swelling or other factors post-operatively.

2. Could vocal cord edema compressing the nerve cause these symptoms? Will her voice return to normal, and if so, how long might that take?
Yes, vocal cord edema can lead to compression of the recurrent laryngeal nerve, resulting in hoarseness or paralysis. If the edema is the primary issue, there is a possibility of recovery as the swelling subsides. Recovery time can vary significantly; some patients may see improvement within weeks, while others may take several months. Voice therapy and monitoring by an ENT specialist can aid in recovery.

3. If the surgery damaged the vocal cord nerve, would the hoarseness be immediate or gradual?
If the recurrent laryngeal nerve is injured during surgery, hoarseness can occur immediately or develop gradually. Immediate hoarseness is often associated with direct trauma during the procedure, while gradual onset may be due to swelling or other post-operative complications. In your mother-in-law's case, the gradual onset of hoarseness after an initial period of normalcy suggests that it may be related to post-operative swelling or nerve irritation rather than direct nerve damage.

4. Could excessive talking after surgery contribute to her hoarseness?
Yes, excessive talking or straining the voice after surgery can exacerbate hoarseness, especially if the vocal cords are already compromised. After any throat or vocal cord surgery, it is generally recommended to limit voice use and avoid straining to allow for healing. If your mother-in-law was speaking extensively soon after her surgery, it could have contributed to her current voice issues.

In conclusion, your mother-in-law's situation is not uncommon following thyroid surgery, particularly with the development of vocal cord paralysis. It is crucial for her to follow up with her ENT specialist for further evaluation and management. Voice therapy may be beneficial, and in some cases, surgical intervention may be considered if there is no improvement over time. Recovery can vary, and patience is essential as her body heals. Regular monitoring and communication with her healthcare providers will be key to her recovery process.

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