Thyroid Cancer Surgery Complications: Vocal Cord Paralysis and Paresis

The recurrent laryngeal nerve also runs in close proximity to the thyroid gland making hoarseness of voice due to partial paralysis an important side effect of thyroid surgery -Wikipedia.


A common and rarely discussed complication of thyroidectomy or thyroid cancer surgery is vocal cord paralysis which can resolve with therapy or may be permanent depending on the extent of nerve damage associated with the cancer itself or the extent of surgery necessary to remove the cancer.

Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of the muscle of the vocal cords. Vocal cord paralysis can affect your ability to speak and even breathe. That's because your vocal cords, sometimes called vocal folds, do more than just produce sound. They also protect your airway by preventing food, drink and even your saliva from entering your windpipe (trachea) and causing you to choke.

• There are a number of causes of vocal cord paralysis including damage to nerves during surgery and certain cancers. Vocal cord paralysis can also be caused by a viral infection or a neurological disorder.

• Treatment for vocal cord paralysis usually includes voice therapy; however, surgery is also sometimes necessary.

Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe. In most cases of vocal cord paralysis, only one vocal cord is paralyzed. If both of your vocal cords are affected, you may have vocal difficulties, as well as significant problems with breathing and swallowing.

Signs and symptoms of vocal cord paralysis may include:

• A breathy quality to the voice
• Hoarseness
• Noisy breathing
• Loss of vocal pitch
• Choking or coughing while swallowing food, drink or saliva
• The need to take frequent breaths while speaking
• Inability to speak loudly
• Loss of your gag reflex
• Ineffective coughing

Vocal Cord Paralysis Basics:

In vocal cord paralysis, the nerve impulses to your voice box (larynx) are interrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes may include:

• Injury to the vocal cord during surgery. Surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck and chest.
• Neck or chest injury. Trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself.
• Stroke. A stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box.
• Tumors. Tumors, both cancerous and noncancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis.
• Inflammation. Arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages, and this inflammation may prevent your vocal cords from opening and closing. The symptoms and signs of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can cause inflammation and damage directly to the nerves in the larynx.
• Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson's disease, you may experience vocal cord paralysis; however, these conditions are more likely to cause vocal cord weakness than complete paralysis.

Factors that increase your risk of vocal cord paralysis include:

• Being female. Women are slightly more likely to develop vocal cord paralysis.
• Undergoing throat or chest surgery. People who need surgery on their thyroid, throat or upper chest have an increased risk of vocal cord nerve damage. Sometimes breathing tubes used in surgery or to help you breathe if you're having serious respiratory trouble can damage the vocal cord nerves.
• Having a neurological condition. People with certain neurological conditions, such as Parkinson's disease, multiple sclerosis or myasthenia gravis, are more likely to develop vocal cord weakness or paralysis.

Vocal Cord Paralysis Complications:

Breathing problems associated with vocal cord paralysis may be so mild that you just have a hoarse-sounding voice, or they can be so serious that they're life-threatening. Because vocal cord paralysis keeps the opening to the airway from completely opening or closing, other complications may include choking on or actually inhaling (aspirating) food or liquid. Aspiration that leads to severe pneumonia is very serious and requires immediate medical care.

When to see a doctor?  If you have unexplained, persistent hoarseness for more than three or four weeks, or if you notice any unexplained voice changes or discomfort, contact your doctor.


Medical Review: 02/18/2012