1. Long-Term Post-Thyroidectomy Dysphagia: Incidence and Risk Factors
Hua G, Alkhateeb A, Huang YQ, Blackburn A, Mlynarek A, Payne R, Hier M.
Otolaryngology – Head & Neck Surgery
Faculty of Medicine, McGill University, Montreal, QC, Canada
Introduction
Results
Conclusions
Symptoms of dysphagia are frequently reported after thyroidectomies, even in uncomplicated operations, and can have long-lasting effects on patients’ health and quality on life. The exact reason for these symptoms is not yet well understood.
Our results shows that the incidence of moderate to severe long-term post-thyroidectomy dysphagia is around %.
While there was no statistically significant correlation between long-term dysphagia and the parameters studied, this study suggests a trend towards a modest association between the transection of the sternothyroid muscle and long-term post-thyroidectomy dysphagia.
Further studies with objective assessments of dysphagia are warranted to rule out any anatomical impairment.
Contact:
Michael P. Hier, MD, FRCSC
Department of Otolaryngology-Head and Neck Surgery
Sir Mortimer B. Davis-Jewish General Hospital
Montreal, QC, Canada.
Table 1. Patient Characteristics classified by Severity of Long-Term Dysphagia
Variable
All
Dysphagia
Control
(None)
p-value
Moderate to Severe
(Mild to None)
Total (%)
206
35 (17.0)
171 (83.0) -
11 (5.34)
195 (94.7)
Mean SIS (range)
1.01 (0-17)
5.91 (1-17)
0 (0-0)
<0.001
10.73 (7-17)
0.46 (0-6)
Sex (%) Male
38 (18.5)
3 (8.57)
35 (20.5)
0 (0)
38 (19.5)
Female
168 (81.6)
32 (91.4)
136 (79.5)
0.149
11 (100)
157 (80.5)
0.222
Mean age (range), years
51.9 (20-90)
51.3 (23-90)
52.0 (20-87)
0.773
55.7 (27-90)
51.7 (20-87)
0.348
Surgical Technique (%) Total Thyroidectomy
140 (68.0)
23 (65.7)
117 (68.4)
1.000
6 (54.5)
134 (68.7)
0.161
Completion Thyroidectomy
16 (7.77)
4 (11.4)
12 (7.02)
0.465
16 (08.21)
0.325
Subtotal Thyroidectomy
50 (24.3)
8 (22.9)
42 (24.6)
5 (45.5)
45 (23.1)
0.140
Left-side
24 (11.7)
20 (11.7)
2 (18.2)
22 (11.3)
Right-side
26 (12.6)
22 (12.9)
3 (27.3)
23 (11.8)
0.539
Sternothyroid Preserved
64 (31.1)
7 (20.0)
57 (33.3)
62 (31.8)
Sternothyroid Transected
142 (68.9)
28 (80.0)
114 (66.7)
0.085
9 (81.8)
133 (68.2)
0.279
Final Pathology (%) Benign
78 (37.9)
12 (34.3)
66 (38.6)
75 (38.5)
Malignant
128 (62.1)
105 (61.4)
0.705
8 (72.7)
120 (61.5)
Nodule/Tumor size (range), cm
2.44 ( )
2.34 ( )
2.46 ( )
0.683
2.14 ( )
2.45 ( )
0.493
Radioactive Iodine Treatment (%)
49 (23.8)
41 (24.0)
0.540
47 (24.1)
0.490
SIS: Swallowing Impairment Score (range 0-24; mild 1-6, moderate 7-9, severe 10-24).
Long-term dysphagia: symptoms lingering beyond 6 months post-thyroidectomy.
Aim
The aim of this study is to discover the prevalence of long-term dysphagia (≥6 months) and identify possible risk factors.
Methods
A retrospective study of 450 consecutive patients undergoing thyroidectomy at a tertiary care academic center from September 2013 to March 2015 was performed.
234 patients were successfully contacted by phone and assessed with the Swallowing Impairment Score (SIS) questionnaire. SIS was used to classify dysphagia as mild if 1-6, moderate if 7-9, and severe if
Dysphagia was compared to patients’ age, sex, nodule size, final pathology, extent & side of surgery, surgical technique, and radioactive iodine (RAI) treatment.
Patients were excluded if they had recurrent laryngeal nerve injury, lateral neck dissection, postoperative hematoma, surgical site infection, radiation/radioactive iodine therapy, or pre-operative dysphagia.
Fig. 1 Swallowing Impairment Score questionnaire; Lombardi et al. World J Surg
References
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Lombardi CP, Raffaelli M, D'Alatri L, Marchese MR, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140(6): ; discussion 32-4.
Lombardi CP, Raffaelli M, D'Alatri L, De Crea C, Marchese MR, Maccora D, et al. Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World journal of surgery. 2008;32(5):
Lombardi CP, Raffaelli M, De Crea C, D'Alatri L, Maccora D, Marchese MR, et al. Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery. 2009;146(6):
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Of 234 patients, 206 met inclusion criteria. 35 of 206 (17%; 95% CI [0.124, 0.228]) had some long-term dysphagia, with a mean SIS of 5.91 (95% CI [4.6, 7.3]).
11 of 206 (5.34%; 95% CI [0.029, 0.094]) patients had moderate to severe long-term post-thyroidectomy dysphagia, with a mean SIS of (95% CI [8.6, 12.8]).
28 of 35 (80%) patients with dysphagia had their sternothyroid muscle transected during surgery, compared to 114 of 171 (66.7%) patients without dysphagia (p=0.085). However, this finding failed to reach statistical significance.
9 of 11 (81.8%) patients with moderate to severe dysphagia had their sternothyroid muscle transected during surgery, compared to 133 of 195 (68.2%) patients with mild to no dysphagia (p=0.279).
Age, sex, surgical technique, final pathology, nodule/tumor size, and RAI also showed no significant association with long-term post-thyroidectomy dysphagia.
Fig. 2 Artist’s Rendition of a Thyroid Gland; verymom.com.