Post-Thyroid Tumor Surgery: Challenges of Oral Feeding After 1 Year

One year and three months after thyroid tumor surgery, the patient has been unable to eat orally?

Hello, Director.
My mother underwent thyroid tumor surgery on June 18, 1999.
It has been 1 year and 3 months since she has been unable to eat orally (due to choking on liquids on September 13, 1999, which led to aspiration pneumonia and her admission to the intensive care unit).
She has been relying on a nasogastric tube for feeding until now, with monthly replacements of the tube and laryngoscopic examinations by the physician.
She still has bilateral vocal cord paralysis.
May I ask, Director: (1) What is the likelihood of gradual improvement? (2) Does National Taiwan University Hospital have the capability to help my mother recover normal oral feeding?

Zhou, 40~49 year old female. Ask Date: 2011/09/17

Dr. Xu Jiazhen reply Otolaryngology

Hello! The recurrent laryngeal nerve, which controls the movement of both vocal cords, is located near the thyroid gland.
When removing a tumor, it is important to consider the position of the nerve, as this often leads to bilateral vocal cord paralysis postoperatively.
One possibility is that the tumor is malignant, and complete removal is necessary for a cure.
Another possibility is that the tumor's extent is too large, causing severe compression on the nerve, making it impossible to preserve its function.
Regardless of the cause of the bilateral vocal cord paralysis, current medical interventions are quite limited.
If there are concerns about aspiration pneumonia and respiratory issues, a tracheostomy may be performed.
In the future, the decision to allow oral feeding will depend on the position of the vocal cords after restoration.
Wishing you good health and well-being!

Reply Date: 2011/09/17

More Info

After thyroid tumor surgery, particularly when complications such as bilateral vocal cord paralysis occur, the challenges associated with oral feeding can be significant. In your mother's case, having been unable to eat orally for over a year and relying on a nasogastric tube for nutrition, it is understandable that you are seeking answers regarding her condition and potential recovery.

1. Possibility of Recovery: The likelihood of spontaneous recovery from bilateral vocal cord paralysis varies widely depending on the underlying cause and the extent of nerve damage. In some cases, if the paralysis is due to temporary nerve injury during surgery, there may be a chance for gradual improvement over time. However, if the nerves were severely damaged or if there is a permanent loss of function, the chances of recovery diminish significantly. Generally, the longer the paralysis persists, the less likely it is to resolve on its own. A thorough evaluation by an otolaryngologist (ENT specialist) is essential to assess the current state of the vocal cords and the potential for recovery.

2. Treatment Options: As for treatment options available at institutions like National Taiwan University Hospital, there are several approaches that may be considered. These include:
- Voice Therapy: Working with a speech-language pathologist can help improve swallowing techniques and vocal cord function. They can provide exercises and strategies to enhance swallowing safety and efficiency.

- Surgical Interventions: If the paralysis is confirmed to be permanent, surgical options such as vocal cord medialization (injection or implant) may be considered to improve airway protection and swallowing function. This procedure can help reposition the vocal cords to close more effectively during swallowing, reducing the risk of aspiration.

- Tracheostomy: In cases where breathing is compromised or aspiration risk is high, a tracheostomy may be performed to secure the airway and allow for better management of respiratory needs.

- Nutritional Support: While awaiting potential recovery, it is crucial to ensure that your mother receives adequate nutrition. If oral feeding remains unsafe, continuing with the nasogastric tube or considering a percutaneous endoscopic gastrostomy (PEG) tube for long-term feeding may be necessary.

- Regular Monitoring: Continuous follow-up with healthcare providers is essential to monitor her condition, assess any changes in her ability to swallow, and adjust treatment plans accordingly.

In summary, while the road to recovery from bilateral vocal cord paralysis post-thyroid surgery can be challenging, there are various strategies and interventions that may help improve your mother's situation. Engaging with a multidisciplinary team, including ENT specialists, speech therapists, and nutritionists, will provide a comprehensive approach to her care. It is important to maintain open communication with her healthcare providers to explore all available options and to set realistic expectations for her recovery journey.

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