A CASE OF NON-RECURRENT INFERIOR LARYNGEAL NERVE IN A PATIENT WITH PAPILLARY THYROID CARCINOMA ASSOCIATED WITH GRAVES' DISEASE

Abstract

We report a 16-year-old famele who was found to have a non-recurrent inferior laryngeal nerve during surgery for papillary thyroid carcinoma complicating Graves' disease. The carcinoma was found in the right lobe of the thyroid during treatment of Graves' disease with antithyroid agents. Decreased T3 and T4 levels, increased TSH level, a positive thyroid rest, positive microsome test, and negativity for thyroglobulin antibody were observed. Computed tomography of the heck revealed a tumor in the upper right lobe of the thyroid and blood vessels around the trachea and posterior aspect of the esophagus. In addition, thyroid scintigraphy showed accumulation of 201T1 and absence of 99mTc in the superior portion of the right lobe of the thyroid. Fine-needle aspiration biopsy confirmed papillary carcinoma. Total thyroidectomy and modified neck dissection of the right side of the neck were performed because metastasis was found in the pretracheal lymph nodes. The left recurrent laryngeal nerve was located in its normal position, but the vagus nerve branched perpendicularly to give rise to the right recurrent as it coursed toward the larynx. The tumor (2.2×2.0×1.8cm in size) was found in a biopsy specimen obtained from the top of the right lobe. Iodine therapy (131I) was performed, and no relapse has been detected during close monitoring of the clinical course.