Acute bilateral vocal fold paresis as a symptom of benign thyroid disease

Abstract

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.

The Prevalence of Undiagnosed Thyroid Disease in Patients With Symptomatic Vocal Fold Paresis

“…In other studies, suggested mechanisms have included nerve compression, neural stretch, perineural vascular insufficiency, and perineural inflammation. [17][18][19] However, most of the benign lesions seen in the patients in the present study did not cause gross enlargement of the involved thyroid lobe, making neural stretch, vascular insufficiency, or nerve compression unlikely causes of the pareses seen in this study. Furthermore, there was no statistically significant difference in the location of the mass and the side of the paresis, suggesting that compression may not be the causative factor in the development of paresis and that other, yet undefined, local factors may play more of a role.…”

The Predictors of Postoperative Laryngeal Nerve Paresis in Patients Undergoing Thyroid Surgery: A Pilot Study

“…The results of a previous study by our group suggest that there may be inflammatory or other mediators from a diseased thyroid that affect functioning of the laryngeal nerve. 15 Although others have proposed various mechanisms to explain how thyroid disease causes LNP or paralysis, including compression of the laryngeal nerves by mass effect of the thyroid or its tumors, stretching of the laryngeal nerves over large thyroid masses or glands, direct involvement of the laryngeal nerves with malignant tumors, or inflammation producing perineural arterial thrombosis and fibrosis with consequent laryngeal nerve dysfunction, 9,[16][17][18] none of these appeared to predict worsening of the LNP, except in the case of goiters and tumors greater than 5 cm in the present study. Six of our subjects had glands larger than 5 cm, which may support the possibility of compression of the nerve or blood supply.…”

Benign disease of the thyroid gland and vocal fold paralysis

“…It is mostly gradual and/or intermittent in onset. Bilateral (McCalla et al, 1987) or contralateral paralysis have rarely been observed (Krecicki et al, 1994;Collazo-Cavell et al, 1995).…”

“…Recurrent laryngeal nerve palsy in association with thyroid disease does not necessarily indicate malignancy but these patients must continue to be regarded as having malignant thyroid disease until proven otherwise (Fenton et al, 1994). In this regard, pre-operative CT scan and particularly fine needle aspiration cytology (FNAC) is indicated (Krecicki et al, 1994) in the diagnostic work-up of thyroid masses and associated vocal fold palsies (Fenton et al, 1994). In patients with benign thyroid disease and a vocal fold palsy early thyroidectomy and relief of nerve compression should provide the greatest chance of recovery.…”