Post-thyroidectomy Horner's syndrome

Perréard, Marion; Bailleul, Hélène; Babin, E.

doi:10.1016/j.anorl.2019.05.013

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Dissection of surrounding structures within the central neck compartment may also cause neuronal injury. A systematic review investigating the rate of HS following anterior cervical disc fusion neck surgery found that, typically, HS was observed as a hyperacute complication in the immediate postoperative period, which is comparable to findings observed in other reported cases of post-thyroidectomy HS [ 6 - 8 ]. Within the context of thyroid cancers, central neck dissection is utilised to reduce the risk of recurrent disease from lymphatic spread.…”

Section: Discussionunclassified

“…Though the characteristic triad of features (ipsilateral ptosis, miosis and facial anhidrosis) may be observed in HS, facial anhidrosis is not typically observed as a feature of post-thyroidectomy HS in other reported cases [ 6 , 8 ] and similarly was not observed in our patient. Investigation using apraclonidine eye drops to confirm the diagnosis of HS is a useful tool [ 15 ].…”

Section: Discussionunclassified

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Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Palmer¹,

Sonoo²,

Jawaid³

et al. 2022

Cureus

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The oculosympathetic chain is a three-neuron pathway responsible for sympathetic innervation to the eye, which follows a complex anatomical course through the head and neck. Neck surgery may cause injury to this pathway, causing loss of sympathetic innervation producing the eponymous Horner's syndrome (ipsilateral ptosis, miosis and anhidrosis), but this is rare in the reported literature. We present the case of a 23-year-old female who underwent total thyroidectomy for a right-sided, metastatic papillary thyroid carcinoma. Following surgery, in the immediate postoperative period, she was noted to have unilateral ptosis and miosis. This patient was assessed by an ophthalmologist due to persistent unilateral ocular symptoms following thyroidectomy. She was subsequently diagnosed with right-sided Horner's syndrome. The diagnosis was confirmed following the observed reversal of her ocular symptoms using apraclonidine 1% minims. The management of Horner's syndrome following thyroidectomy is conservative if no evidence of compressive hematoma or seroma is identified as in this case. The patient was followed up at six weeks following thyroidectomy and a partial improvement in ptosis was noted. The patient also reported blurred vision secondary to increased refractive error due to reduced pupillary function in her right eye. Prognosticating recovery from Horner's syndrome following thyroidectomy is challenging due to limited evidence. Horner's syndrome as a possible complication of thyroidectomy should be counselled to patients pre-operatively. A residual deficit from Horner's syndrome may cause functional impairment in addition to the poor cosmetic outcome.

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Section: Discussionunclassified

Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Palmer¹,

Sonoo²,

Jawaid³

et al. 2022

Cureus

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“…On PubMed, the first paper addressing CSC damage during surgeries for thyroid disorders was published in 1965 [ 57 ]. The first ever case of post-thyroidectomy HS dates from 1915 [ 58 ].…”

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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“…In addition, only 4 cases among these patients were due to the ETS. The clinical characteristics of the cases are summarized in Table 2 [4,6,7,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Among these patients, the patients with HS most commonly underwent TT with lymph node dissection, especially with lateral lymph node dissection (LLND) [4,6,7,14,20,[23][24][25][26][28][29][30].…”

Section: Neuroanatomy and Etiology Of Hsmentioning

confidence: 99%

Case report and literature review: Horner syndrome subsequent to endoscopic thyroid surgery

et al. 2021

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Background Horner syndrome (HS), mainly characterized by symptoms including ptosis, miosis, and anhidrosis on the affected face, is a condition that is well documented but rarely reported as a postoperative complication of thyroidectomy, particularly in endoscopic thyroid surgery (ETS). We hereby report a case of HS due to ETS with a brief literature review on this topic. Case presentation A 31-year-old female was admitted to our hospital with an unexpected physical examination finding of two thyroid nodules that were hypoechoic, had an irregular shape, and exhibited calcification. Subsequently, the results of a fine-needle aspiration (FNA) biopsy from the thyroid nodules and BRAFV600E mutation further confirmed the malignancy of these nodules. Thus, total thyroidectomy combined with central lymph node dissection (CLND) by ETS via the bilateral axillo-breast approach was performed on this patient. Histology confirmed the diagnosis of papillary thyroid microcarcinoma (PTMC) concurrent with Hashimoto’s thyroiditis (HT). However, this patient developed HS with ptosis in her left eye on postoperative day 3. All symptoms gradually resolved before the 3-month follow-up. Conclusion HS subsequent to ETS is a rare complication. Thus, standardized and appropriate operative procedures, as well as subtle manipulation, are essential in preventing and reducing the occurrence of HS. In addition, the early diagnosis and management of this rare complication are also important for a favorable outcome.

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Post-thyroidectomy Horner's syndrome

Cited by 4 publications

References 3 publications

Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Case report and literature review: Horner syndrome subsequent to endoscopic thyroid surgery

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