Iatrogenic Horner's syndrome: a rare complication of thyroid surgery

Silva, Wdd de; Soysa, Msm de; Perera, BL

doi:10.4038/cmj.v55i4.2639

Cited by 11 publications

(3 citation statements)

References 2 publications

(3 reference statements)

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“…Few cases have been reported since, and the majority of cases are associated with conventional thyroidectomy (8). To the best of our knowledge, there have been only 18 cases involving the development of HS as a complication of conventional thyroid surgery since 1993 (Table II) that have been reported in the literature (3,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Due to the development of surgical techniques over the previous two decades, cervical sympathetic damage has also been reported as a post-operative complication that develops subsequent to the completion of open minimally-invasive thyroidectomy and robotic-assisted endoscopic thyroidectomy (Table II).…”

Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

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Abstract. Horner's syndrome (HS), characterized by a combination of ptosis and miosis, is an uncommon complication of thyroid surgery, particularly in minimally invasive thyroid surgery. Two cases of HS were observed secondary to minimally invasive video-assisted thyroidectomy in the Department of Thyroid Breast Surgery of Zhejiang Provincial People's Hospital between August 2012 and July 2014. The two patients developed miosis and ptosis following total thyroidectomy; all symptoms had resolved at 1 and 11 months subsequent to surgery, respectively. HS has currently been reported secondary to numerous types of minimally invasive thyroid procedures. The literature was reviewed to identify cases of this iatrogenic complication secondary to each type of thyroidectomy and the possible injury mechanisms underlying the syndrome were summarized in the present study. In addition, factors that were associated with minimally invasive thyroidectomy, such as the limited endoscopic vision during the procedure, the retraction effect and the occurrence of thermal damage from the use of the harmonic scalpel, were emphasized. The present study concluded that close attention is required during minimally invasive thyroid surgery in order to avoid HS as a complication of the procedure.

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Section: Discussionmentioning

confidence: 99%

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Meng¹,

Tian²,

Lv³

et al. 2015

Oncology Letters

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“…The most common mechanism of injury of the cervical sympathetic nerve is direct involvement of tumor of inflammation lesions, and the most common sites are prevertebral fascia, paratracheal area, posteromedial area of the carotid sheath, and lung apex [11]. Many studies have reported that Horner syndrome appeared after cervical surgery, but thyroid-surgery associated Horner syndrome is rare [12] [13]. In this report, we presented two typical Horner's syndrome after thyroid surgery.…”

Section: Discussionmentioning

confidence: 74%

Horner’s Syndrome after Thyroidectomy: Two Cases Report

Huang¹,

Tang²,

Su³

2018

OJPM

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Background: Horner's syndrome is defined as a combination of a series of symptoms following the injury of oculosympathetic pathway. This dysfunction is usually acquired during cervical surgery but rarely triggered by thyroid-surgery. Case Presentation: Here we present two cases secondary to thyroidectomy. Two young female patients, both diagnosed as tumor in left lobe of thyroid, had Horner's syndrome after surgery. Fortunately, Horner's syndrome was relieved after steroid treatment. Conclusions: Indirect mechanism involved in the lesion and the direct factor with mistaken section of nerve fibers may be responsible for Horner's syndrome. Besides, Horner's syndrome after thyroid surgery may be revisable after oral steroid treatment.

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“…Early identification of HS after thyroid surgery might increase the potential of reversibility [ 76 , 77 ]. Of note, we mention the case of a 27-year-old male who suffered a total thyroidectomy with lateral neck dissection for a papillary thyroid carcinoma and developed HS within the first 2 h after surgery (partial remission after 2 months under conservative management) [ 78 ].…”

Section: Thyroid Conditions and Hs And Lymphocele/chylous Leakagementioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Iatrogenic Horner's syndrome: a rare complication of thyroid surgery

Cited by 11 publications

References 2 publications

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Horner's syndrome subsequent to minimally invasive video-assisted thyroidectomy in two patients

Horner’s Syndrome after Thyroidectomy: Two Cases Report

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

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