Esophageal Motility Changes after Thyroidectomy; Possible Associations with Postoperative Voice and Swallowing Disorders: Preliminary Results

Scerrino, Grégorio; Inviati, Angela; Giovanni, Silvia Di; Paladino, Nunzia Cinzia; Paola, Valentina Di; Re, Giuseppe Lo; Almasio, Piero Luigi; Cetta, Francesco; Gulotta, Gaspare; Bonventre, Sebastiano

doi:10.1177/0194599813482299

Cited by 52 publications

(108 citation statements)

References 21 publications

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“…In the paragraph, ''effect of thyroidectomy on the trachea and respiratory and oesophageal function'' they appeal to the same articles mentioned in this paper, Scerrino et al's one and our own article [10,18]. In the former, effects are seen as a decrease pressure of the UES; we have, instead, registered a normal hyoid bone elevation, even if we established a different relationship between surgery and LPR.…”

Section: Discussionmentioning

confidence: 72%

“…In the post-operative follow-up, all patients showed a significant decrease in UES pressure, no difference for the LES values, unchanged body motility. As far as swallowing disorders are concerned, clinical symptoms were strictly connected to the UES changes while the voice discomforts were linked to the proximal acid reflux [18].…”

Section: °Hypothesis: the Upper Esophageal Sphinctermentioning

confidence: 99%

See 1 more Smart Citation

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Cusimano

Macaione

Fiorentino

2015

Eur Arch Otorhinolaryngol

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Swallowing, voice disorders, throat discomfort and subjective neck discomfort are usually reported by patients with a known thyroid nodule and are correlated to nodular thyroid disease itself. Moreover, in endemic goitrous areas, total thyroidectomy (TT) is the most frequently performed surgical procedure. We are used to relate swallowing, voice and throat discomfort to the mechanical effects of nodular goiter or to thyroidectomy itself, but in both these cases the relationship between symptoms and the thyroid mass or its removal is not always clear or easily demonstrated. How can we explain the persistence of local neck symptoms after TT? And how can TT worsen the dysphagic or dysphonic disorders attributed to the goiter's effect over the surrounding structures? During these years, many articles have analyzed the relationship between the thyroid disease and the laryngopharyngeal reflux, finding more and more evidences of their consensuality, leading to important new management considerations and notable medico-legal implications; if the reason of local neck symptoms is not the thyroid disease, we have to study and specially cure the reflux disease, with specific test and drugs. Therefore, the aim of our study, relying on the published literature, was to investigate how, in demonstrated presence of reflux laryngopharyngitis in patients with nodular goiter and local neck symptoms before and after uncomplicated TT, the surgery could influence our anti-reflux mechanism analyzing the anatomical connection as well as the functional coordination; can we play a part in the post-operative persistence of swallowing and voice alterations and throat discomfort?

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Section: Discussionmentioning

confidence: 72%

Section: °Hypothesis: the Upper Esophageal Sphinctermentioning

confidence: 99%

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

Cusimano

Macaione

Fiorentino

2015

Eur Arch Otorhinolaryngol

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“…Several recent studies have emphasized various advantages of hemithyroidectomy [31,32] in selected cases of malignancy [33,34]. Further observations may reinforce the support of HT such as voice and swallowing disorders that have been evaluated in association with TT [35,36]. However, the data concerning these complaints after HT are limited [37].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Scerrino¹,

Raspanti²,

Attard³

et al. 2017

Langenbecks Arch Surg

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Purpose Chronic asthenia (CA) is complained by some patients that have undergone thyroid surgery. We evaluate its impact in patients undergoing unilateral or bilateral thyroidectomy, the trend during a 1-year follow-up, and the possible risk factors. Methods A prospective, cohort study was carried out on 263 patients scheduled for thyroidectomy from 2012 and 2014. Exclusion criteria were as follows: Graves' disease, malignancies requiring radioiodine therapy, post-surgical hypoparathyroidism, laryngeal nerve palsy, abnormal pre-and postoperative thyroid hormone levels, and BMI outside the normal range. Demographics; smoking and alcoholism addiction; cardiac, pulmonary, renal, and hepatic failure; diabetes; anxiety; and depression were recorded. The Brief Fatigue Inventory (BFI) was used to evaluate CA and its possible association with these comorbidities 6 and 12 months after thyroidectomy. Results One hundred seventy-seven patients underwent total thyroidectomy (TT), 54 hemithyroidectomy (HT). Thirty-two patients were not recorded because of the onset of exclusion criteria. In the 6 months after thyroidectomy, in the TT group, 64 patients (36.16%) reported an impairment in the BFI score and only 1 in the TL group. The mean BFI score changed from 1.663(±1.191) to 2.16 (±11.148) in the TT group, from 1.584 (±1.371) to 1.171 (±1.093) in the TL group (p < 0.001). No further significant variations in BFI were reported 1 year after surgery. Conclusions CA worsened after TT, but not after HT. Apart from operative procedure itself, no other risk factor was found be significantly associated with post-thyroidectomy asthenia. Further investigation is needed to determine the causes of CA.

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“…Patients candidate to thyroidectomy or other neck procedures, such as parathyroidectomy, often complain voice and swallowing disorders [1,2].…”

Section: Introductionmentioning

confidence: 99%

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review

Scerrino

Tudisca

Bonventre

et al. 2017

International Journal of Surgery

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Introduction Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. Methods We reviewed the current literature available on MEDLINE database, concerning the swallowing disorders appearing after the thyroidectomy. The articles included in the review reported pathophysiology and diagnostic concerns. Results Twenty articles were selected for inclusion in the review. Depends on the possible causes of the difficulty swallowing (related to nerve damage or appearing after uncomplicated thyroidectomy), different types of diagnostic procedures could be used to study patient discomfort, as well as intraoperative nerve monitoring, fiber optic laryngoscopy, endoscopy, pH monitoring, esophageal manometry and videofluorography. Among all these procedures, videofluorography is considered the gold standard to evaluate the entire swallowing process, since that allows a real-time study of all the three phases of swallowing: oral phase, pharyngeal phase and esophageal phase. Conclusion The diagnostic procedures described can help to identify the mechanisms involved in swallowing disorders, with the aim to choose the best therapeutic option. More studies are needed for understanding the causes of the dysphagia appearing after thyroidectomy

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Esophageal Motility Changes after Thyroidectomy; Possible Associations with Postoperative Voice and Swallowing Disorders: Preliminary Results

Abstract: After uncomplicated thyroidectomy, decreased upper esophageal pressure may explain both pharyngeal (dysphagia) and laryngeal (vocal impairment) exposure to acid. In the future, proton pump inhibitor therapy protocols should be evaluated.

Cited by 52 publications

References 21 publications

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review

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