Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Thyroid cancer quality of care indicators: A scoping review

BACKGROUND

Thyroid cancer, the most common endocrine malignancy, has highly variable practice patterns. This scoping review aimed to identify quantitative and qualitative quality of care indicators (QIs) essential for providing optimal care in thyroid cancer management.

METHODS

A comprehensive search across MEDLINE, EMBASE, PubMed, and Web of Science identified QIs defining structures, processes, and outcomes in five care phases: pre-diagnosis, diagnosis, treatment, post-treatment surveillance, and end-of-life care.

RESULTS

Of the 3,143 articles screened, 36 were included, yielding 135 unique QIs. Key diagnostic QIs were the use of a standardized ultrasound reporting system (n ​= ​4), diagnostic fine needle aspiration biopsy (FNAB) (n ​= ​3), and FNA cytology reporting with the Bethesda System (n ​= ​3). Common treatment QIs included thyroidectomy by high-volume surgeons (≥10-32 cases/year) (n ​= ​7), preoperative voice assessment for high-risk patients (n ​= ​4), and recurrent laryngeal nerve monitoring (n ​= ​3). Serum thyroglobulin (Tg) monitoring was the primary post-treatment QI for recurrence (n ​= ​2).

CONCLUSIONS

Developing an evidence-based QI list can identify care gaps, direct targeted interventions, promote care standardization, and improve outcomes for thyroid cancer patients.

Summary of the best evidence for vocal rehabilitation training in adults with unilateral vocal fold paralysis

Purpose

To search, evaluate, and summarize the relevant evidence of voice rehabilitation training in adults with unilateral vocal fold paralysis (UVFP).

Methods

Using the '6S' model, the database of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and voice rehabilitation training for adults with UVFP were systematically searched. The search includes clinical decisions, guidelines, systematic reviews, randomized controlled trials, and expert consensus. Data search since the establishment of the database to 27 November 2023. The quality evaluation of the literature methodology and the extraction and integration of evidence were carried out independently by two researchers.

Results

A total of 12 literature were included, including 2 systematic reviews, 2 expert consensus, 4 guidelines, 2 clinical decisions, and 2 randomized controlled trials. Four categories of 16 pieces of evidence were summarized: evaluation of vocal cord paralysis, voice rehabilitation training, health education, joint decision-making, and multidisciplinary cooperation.

Conclusion

This study summarized the best evidence of voice rehabilitation training for adults with UVFP and provided evidence-based summary for clinical staff to carry out relevant interventions.

Knowledge, Attitudes, and Practices Regarding Voice Disorders After Thyroid Surgery: A Cross-Sectional Study Among Patients in Southwestern Mainland China

BACKGROUND

It is not clear to what extent patients with thyroid disease are knowledgeable about voice health. This study investigated patients' awareness and practices concerning voice disorders post-thyroidectomy and their willingness for further education.

METHODS

This study was a cross-sectional observational survey conducted at the Department of Thyroid Surgery, West China Tian Fu Hospital, between February and May in 2024. The questionnaire consists of four sections; descriptive analysis, correlation analysis, and logistic analysis were used for statistical analysis.

RESULTS

A total of 248 participants were included, with 94% of participants reporting no dysphonia at present but expressing concern about postoperative voice change (with an average anxiety level of 6.43 out of 10). Among all participants, 53.2% were aware of postoperative voice change as a complication before hospitalization, and this percentage increased to 85.5% after surgery. A total of 77.8% of them reported that undergoing an examination before surgery was "absolutely necessary" or "necessary." Participants have limited understanding of the symptoms of voice disorders, methods of voice assessment, and causes of postoperative voice disorders. The most common source of knowledge was preoperative conversations with surgeons (63.3%). However, participants exhibited a positive attitude toward the treatment of voice disorders after thyroid surgery (87.5%) and were willing to receive knowledge on vocal hygiene (91.9%).

CONCLUSIONS

In this study, participants displayed inadequate knowledge about voice disorders following thyroid surgery but took proactive steps to manage it. They generally preferred conservative treatment options for postoperative voice disorders. Additionally, the results revealed a strong interest among patients in receiving further education on managing voice disorders after surgery. Therefore, enhancing education can help facilitate timely medical consultations for patients with postoperative voice disorders and improve their overall postoperative quality of life.

Comparison of the Effectiveness of Injection Laryngoplasty Using Autologous Platelet-Rich Plasma or Autologous Fat With Platelet-Rich Fibrin for the Treatment of Patients With Unilateral Vocal Fold Paralysis

OBJECTIVES

Unilateral vocal fold paralysis (UVFP) can be idiopathic or a result of surgery, cancer, or neurological disease. The most common presentation is dysphonia, which causes problems with communication, and can lead to anxiety and depression. Injection laryngoplasty (IL) is a current means of treatment, but there have been few studies to determine the optimal material to use. Therefore, we aimed to compare the use of autologous platelet-rich plasma and autologous fat with platelet-rich fibrin for IL under local anesthesia and general anesthesia, respectively.

STUDY DESIGN

A prospective randomized controlled study was conducted at the Otolaryngology-Head and Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University.

METHODS

Thirty-four patients with UVFP were recruited. All met the inclusion criteria and were randomized to two groups, to be treated using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin under general anesthesia. The primary outcome was the mean difference in the Voice Handicap Index (VHI) between the groups at 1- and 6-months post. The secondary outcomes were the mean differences in voice acoustic parameters [maximum phonation time (MPT), jitter, shimmer, and harmonic-to-noise ratio (HNR)] between the groups at these time points.

RESULTS

At the measured time points, there were no significant differences in the mean VHIs (P = 0.462), MPT (P = 0.79), jitter (P = 0.234), shimmer (P = 0.863), or HNR (P = 0.096) between the groups. Few people who underwent the procedure under local anesthesia developed laryngospasm, while some of those in the fat with platelet-rich fibrin developed postoperative abdominal contusion or hematoma which resolved spontaneously.

CONCLUSIONS

We have found no difference in the effectiveness of IL using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin performed under general anesthesia in patients with UVFP. No serious or life-threatening complications were found in both groups.

Feasibility of active surveillance in patients with clinically T1b papillary thyroid carcinoma ≤1.5 cm in preoperative ultrasonography: MASTER study

Objective

Active surveillance (AS) is generally accepted as an alternative to immediate surgery for papillary thyroid carcinoma (PTC) measuring ≤1.0 cm (cT1a) without risk factors. This study investigated the clinicopathologic characteristics of PTCs measuring ≤2.0 cm without cervical lymph node metastasis (cT1N0) by tumor size group to assess the feasibility of AS for PTCs between 1.0 cm and 1.5 cm (cT1b≤1.5).

Design

This study enrolled clinically T1N0 patients with preoperative ultrasonography information (n= 935) from a cohort of 1259 patients who underwent lobectomy and were finally diagnosed with PTC from June 2020 to March 2022.

Results

The cT1b≤1.5 group (n = 171; 18.3 %) exhibited more lymphatic invasion and occult central lymph node (LN) metastasis with a higher metastatic LN ratio than the cT1a group (n = 719; 76.9 %). However, among patients aged 55 years or older, there were no significant differences in occult central LN metastasis and metastatic LN ratio between the cT1a, cT1b≤1.5, and cT1b>1.5 groups. Multivariate regression analyses revealed that occult central LN metastasis was associated with age, sex, tumor size, extrathyroidal extension, and lymphatic invasion in patients under 55, while in those aged 55 or older, it was associated only with age and lymphatic invasion.

Conclusion

For PTC patients aged 55 years or older with cT1b≤1.5, AS could be a viable option due to the absence of a significant relationship between tumor size and occult central LN.

Role of Prehabilitation and Rehabilitation on Functional Recovery and Quality of Life in Thyroid Cancer Patients: A Comprehensive Review

BACKGROUND

This narrative review aims to provide a comprehensive overview of the current prehabilitation and rehabilitation strategies for thyroid cancer survivors to optimize functional outcomes and enhance their quality of life.

METHODS

The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus.

RESULTS

The review emphasizes the role of a comprehensive rehabilitation approach in targeting the different domains that generate disability in thyroid cancer patients. In this context, physical activity, range of motion exercises, myofascial release, joint mobilization, and postural exercises are crucial for improving functional outcomes and reducing treatment-related discomfort and disability. Moreover, tailored rehabilitative management addressing dysphonia and dysphagia might have a positive impact on the quality of life of these patients. Despite these considerations, several barriers still affect the implementation of a multimodal rehabilitative approach in common clinical practice. Thus, sustainable and effective strategies like digital innovation and patient-centered approaches are strongly needed in order to implement the rehabilitative treatment framework of these subjects.

CONCLUSIONS

This narrative review provides valuable insights into the current prehabilitation and rehabilitation strategies to treat thyroid cancer survivors, addressing physical, psychological, and vocational needs to optimize functional outcomes and enhance their quality of life.