Local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngopharyngitis

Abstract

Local symptoms in the neck such as swallowing and voice disorders, and throat discomfort might be related to a goiter if present, but are also reported by patients suffering from reflux laryngopharyngitis. The aim of our study was to investigate the presence of reflux laryngopharyngitis in patients with nodular goiter before and after uncomplicated total thyroidectomy (TT) using a prospective study in University Hospital setting. We considered 25 patients, affected by non-toxic nodular goiter and candidates for TT, who complained of local symptoms in the neck. All the patients were carefully interviewed, with emphasis on swallowing and voice disorders, throat discomfort and reflux-related symptoms and underwent a videolaryngoscopy (VLS) and a videofluoroscopic swallowing study (VFSS) before and 3 months after TT. Before thyroidectomy, reflux laryngopharyngitis-related alterations were present in 68 and 50% at VLS and VFSS, respectively. After thyroidectomy, the swallowing and voice disorders persisted in 79 and 75%, respectively, while throat discomfort persisted in 91%. The results show that patients with a non-toxic nodular goiter who complain of local neck symptoms, before surgery it is appropriate to see if a reflux laryngopharyngitis is present; VLS and VFSS could be indicated for this and if necessary an antireflux treatment should be administered.

How uncomplicated total thyroidectomy could aggravate the laryngopharyngeal reflux disease?

“…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.…”

“…In our article titled ''local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngopharyngitis'' [10], we claim that the above-mentioned symptoms are not related to the goiter's compression/dislocation/infiltration, but rather to another medical disease characterized by a similar clinical manifestation. In more detail, we assume that the reflux laryngopharyngitis is the primum movens of these symptoms, a different diagnosis with an overlapping clinical presentation.…”

“…In our study [10], we evaluated the swallowing activity pre-and post-thyroidectomy to investigate how the surgical procedure could modify it. Once defined the possible reflux-linked origin of the local neck symptoms, could the swallowing study explain the extent to which surgery worsen the normal swallowing sequence to induce the reflux injury?…”

“…Furthermore, in endemic goitrous areas, total thyroidectomy (TT) is the most frequently performed surgical procedure [10].…”

“…Traditionally, they have been related either to a supposed injury to the perivisceral neural plexus innervating the pharyngeal and laryngeal structures or to a normal healing process presumed to result in laryngo-tracheal fixation with impairment of vertical movements [10]. We are used to relate swallowing, voice and throat discomfort to the mechanical effects of nodular goiter or to thyroidectomy, but in both cases it is not always clear, nor it has been efficiently demonstrated, to what extent these symptoms can be related to the thyroid mass or to its removal.…”