A rare etiology of bilateral vocal fold immobility: Multinodular goiter

Abstract

Objectives: The differential diagnosis of bilateral vocal fold immobility (BVFI) includes complication of nerve injury after thyroidectomy, malignancy, trauma, neurologic or idiopathic causes. We present a case of BVFI secondary to a large multinodular goiter of the thyroid gland. Review of the literature reveals only 2 other cases of multinodular goiter-related BVFI. Methods: A 62-year-old man was referred to the otolaryngology clinic for a left neck mass. His medical history was unremarkable for stroke, history of intubation, prior malignancy, or smoking. He denied dyspnea, stridor, weight loss, voice changes, or dysphagia. Physical exam revealed a left paramedian, 6 cm, nontender, soft neck mass. The remainder of the head and neck exam was unremarkable except for the finding of bilateral vocal fold immobility and a 4 mm glottic aperture. Subsequent thyroid ultrasound imaging revealed markedly enlarged thyroid lobes with heterogenous echotexture. Computed tomography of the neck and chest with contrast revealed a large heterogenously enhancing multinodular thyroid and no lymphadenopathy of the neck, skullbase tumors, or other mediastinal abnormalities were present. Fine needle aspiration was performed without evidence of malignancy and the patient underwent total thyroidectomy and elective open tracheotomy. Results: Histology revealed nodular hyperplasia with 2 foci of micropapillary carcinoma in the right lobe of the thyroid. The patient was decannulated 6 months postoperatively with markedly improved right true vocal cord mobility. Conclusion: BVFI secondary to multinodular goiter may not completely resolve after resection of the causative goiter. Multinodular goiter, albeit rare, should be included in the differential diagnosis of BVFI.