Administration of Radioactive Iodine Therapy Within 1 Year After Total Thyroidectomy Does Not Affect Vocal Function

Laryngeal Electromyography as a Predictive Factor in the Evolution of Unilateral Recurrent Paralysis Post-Thyroidectomy

Background: Dysphonia, a common symptom after thyroid surgery, is most often caused by damage to the recurrent laryngeal nerve. Laryngeal electromyography (LEMG) is used as a qualitative diagnostic tool to distinguish neurological etiology from other causes of dysphonia. The purpose of this study is to establish the value of LEMG as a predictor factor in the recovery of unilateral recurrent paralysis post-thyroidectomy. Methods: This study included 11 patients with unilateral vocal fold palsy (UVFP) evidenced on the videostrobolaryngoscopy (VSL) after thyroidectomy. Electrical activity of thyroarytenoid (TA) muscles of the patients included in the study was recorded through LEMG and the prognosis of the lesions was classified as excellent, fair, or poor based on the presence of spontaneous activity and motor unit recruitment. Results: LEMG at the first clinic visit showed an excellent prognosis in three of the cases, a fair prognosis in three of the cases, and five of them indicated a poor prognosis. At 6 months after the first LEMG, patients with a poor prognosis were unchanged and showed no LEMG improvement. Those with an excellent prognosis showed an increased recruitment response, and LEMG was normal. In one patient with a fair prognosis and minimal spontaneous activity, LEMG recruitment decreased during reevaluation. The other two fair-prognosis patients had a normal LEMG. Conclusions: A correlation was found between LEMG findings and functional recovery of the vocal cords, demonstrating that the presence of spontaneous activity represents a negative prognostic factor. However, due to limited patient cohorts, the sensitivity of the LEMG as a prognostic tool in the functional recovery of the larynx is not yet established and requires further research.

Prospective voice assessment after uncomplicated thyroidectomy: A comprehensive analysis of a single centre experience

OBJECTIVES

Voice change after uncomplicated thyroidectomy has been an important issue in the field of thyroid surgery. The aim of this study was to promote understanding of voice change after uncomplicated thyroidectomy by analysing the results for a large number of patients from a single institute.

DESIGN

We retrospectively reviewed the medical records of 2879 consecutive patients who underwent thyroidectomy and voice evaluation between January 2014 and December 2019 in a single institute. All the patients had their vocal status assessed using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) scores preoperatively and at 1, 3, and 6 months postoperatively. We analysed the pattern of voice changes over time and differences in voice parameters based on clinical factors. To confirm the usefulness of the TVSQ, the correlation between TVSQ scores and objective parameters was analysed. Lastly, predictive factors for persistent voice symptoms were analysed.

SETTING

Tertiary referral hospital.

RESULTS

The frequency ranges and TVSQ scores exhibited significant deterioration until 6 months following surgery. Among clinical factors, the extents of thyroidectomy and neck dissection were associated with worse voice parameters. The TVSQ score was significantly correlated with objective voice parameters. The extents of thyroidectomy and neck dissection were predictive of persistent voice symptoms at 6 months after thyroidectomy.

CONCLUSION

After uncomplicated thyroidectomy, most voice parameters tended to recover, but some parameters remained aggravated even at 6 months after surgery. With more extensive surgery, worse voice quality and the higher risk of persistent voice symptoms may be anticipated.

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

Voice change is a common complaint after thyroid surgery and has a significant impact on quality of life. The Korean Society of Laryngology, Phoniatrics and Logopedics assembled a task force to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations encompass preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, and include in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQs) in three categories-preoperative (KQ 1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management-and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. A detailed evidence profile is presented for each recommendation. The level of evidence for each recommendation was classified as high-quality, moderate-quality, or low-quality. The strength of each recommendation was designated as strong or weak considering the level of evidence supporting the recommendation. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

Singing voice range profile: New objective evaluation methods for voice change after thyroidectomy

BACKGROUND

After surgery in the thyroid region, patients may present with phonation or singing difficulty, even within their vocal range. We designed a novel voice evaluation method that reflects subjective and objective voice complications of the surgery.

METHODS

This tool recorded patients' voice ranges while singing, which was named the singing voice range profile (singing VRP). Patients were asked to sing "Happy Birthday," which has a one-octave scale, at a comfortable tone and intensity. The singing VRP, standard VRP and voice handicap index-10 (VHI-10) results were recorded before thyroidectomy and 1 and 3 months after thyroidectomy for 128 patients. For subgroup analysis, a group where the maximum F₀ of standard VRP in 1 month postoperatively was lower than the highest singing F₀ of the preoperative singing VRP was defined as "Collapsed group" and the other group was "Preserved group."

RESULTS

The changes in the highest, lowest and range of singing fundamental frequency (F₀ ) had decreased at 1 month postoperatively. Subsequently, they had improved significantly at 3 months postoperatively but were lower than those preoperatively (all P < .05, except for the change in the lowest singing F₀ between 1 and 3 months postoperatively, P = .274). In the subgroup analysis, the singing range of the collapsed group (n = 65) showed significantly lower VHI-10 scores, range of vocal F₀ and singing F₀ than those of the preserved group (n = 63) at 1 and 3 months postoperatively (all P < .001). At 3 months postoperatively, the singing F₀ range in the preserved group had recovered to the range before surgery (13.0 ± 1.3 vs. 13.1 ± 1.4, P = .746 for the preserved group, and 13.0 ± 1.3 vs 11.5 ± 2.4, P < .001 for the collapsed group).

CONCLUSIONS

Parameters measured by singing VRP showed a trend similar to the change in VHI-10 and the maximum F₀ of standard VRP. In addition, singing VRP allowed a qualitative classification of the postoperative voice function when combined with standard VRP. Therefore, it can be used as a supplementary voice evaluation tool to reflect the physiologic and functional aspects of voice.

Development and Evaluation of a Korean Version of a Thyroid-Specific Quality-of-Life Questionnaire Scale in Thyroid Cancer Patients

Purpose

The purpose of this study was to develop a Korean version of the self-reported thyroid-specific quality of life (QoL) questionnaire for thyroid cancer patients (KT-QoL), and to evaluate its reliability and validity.

Materials and Methods

Two hundred seventy-two patients who underwent thyroidectomy from January to December 2010 were recruited in this study. The original version of the thyroid QoL was translated into Korean and evaluated for its reliability and validity. Using the developed KT-QoL, the postoperative QoL was evaluated until postoperative 1 year.

Results

At the preoperative baseline, the item internal consistency (IIC) ranged from ‒0.19 to 0.76, with low IIC values for items 2, 17, and 27. Item discriminant validity ranged from 86% to 97%. These values were similar at the postoperative periods. The internal consistency reliability (Cronbach’s α) was high for all dimensions, ranging from 0.90 to 0.95. The test-retest reliability (intraclass correlation coefficient) was acceptable (0.74-0.82). The external validity examined by the correlation between the item 1j (voice changes) of KT-QoL and the voice handicap index-30 ranged from 0.51 to 0.75. Patients’ QoL scores decreased after surgery, which demonstrated the sensitivity of the questionnaire. The QoL scores in patients with lobectomy showed best QoL scores postoperatively and those with receiving radioactive iodine still showed decreased QoL scores along the postoperative periods.

Conclusion

These results demonstrate that KT-QoL is a valid instrument for evaluating QoL of Korean patients with thyroid cancer.

Effects of Radioactive Iodine Ablation Therapy on Voice Quality

OBJECTIVE

The goal of this study was to evaluate the effects of radioactive iodine ablation therapy on voice quality of patients diagnosed with well-differentiated thyroid carcinoma.

METHODS

We enrolled 36 patients who underwent total or subtotal thyroidectomy due to well-differentiated thyroid carcinoma. Voice recordings from patients were analyzed for acoustic and aerodynamic voice. The Voice Handicap Index-10 was used for subjective analysis. The control group consisted of 36 healthy participants. Results taken before and after therapy were compared statistically.

RESULTS

There were no differences in the results taken before and after therapy for the radioactive iodine ablation group. The Voice Handicap Index-10 results did not differ between groups before and after therapy.

CONCLUSION

Radioactive iodine ablation therapy has no effect on voice quality objectively or subjectively.