Audit of Neurological Complications After Thyroid Surgery

Abstract

The incidence of permanent neurological complications after thyroid surgery is less than 2% and rarely life threatening. Most of the reported neurological complications are related to changes in voice or breathing difficulty. Symptoms of a foreign body sensation in the throat are an unpleasant and persistent complication, which has rarely been reported after thyroid surgery. Analysis of records of 170 patients undergoing various types of thyroid operations over a 6-year period was done. Postoperative complications with emphasis on the neurological complications were documented. The common post-thyroidectomy neurological complications noted were hoarseness of voice (6 patients), loss of voice pitch (7), breathy voice (8), respiratory stridor (2), and dysphagia to liquids (8). Most of these were transient and recovered spontaneously within weeks. Furthermore, we report a foreign body/sticky sensation in the throat as an atypical neurological complication. It was found to occur in 5 patients and significantly persisted in 3 patients at a 6-month follow-up after surgery. The postoperative symptoms commonly noticed after thyroid surgery were related to the motor innervation component of the external branch of the superior laryngeal or the recurrent laryngeal nerve. These symptoms underwent spontaneous resolution over a few weeks period after surgery in most of the patients. Additionally, we documented a foreign body sensation in the throat in 5 patients which is possibly a sequela of sensory denervation of the supra-glottic mucosa in the region supplied by the internal branch of the superior laryngeal nerve. Unlike motor symptoms, this foreign body sensation persisted in 3 out of 5 patients (60%) at 6 months of follow-up.