Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy.

BACKGROUND: Voice and throat dysfunction may occur in patients after thyroidectomy, even in the absence of apparent laryngeal nerve injury. We evaluated the impact of thyroid surgery on voice and throat function using perceptive, objective, and subjective measurements in a prospectively enrolled and serially followed cohort of thyroid cancer patients. We assessed the impact of surgical extent and intensity of postoperative treatment, including addition radioactive iodine treatment (RIT), on these functions.
METHODS: Consenting patients undergoing thyroid lobectomy (TL; n = 33), total thyroidectomy (TT; n = 41), or TT plus RIT (n = 81), none of whom had laryngeal nerve dysfunction perioperatively, were enrolled prospectively. All underwent comprehensive functional evaluations, including perceptive voice quality using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale and acoustic voice analysis with multiple parameters, and filled out subjective questionnaires, including the Voice Handicap Index (VHI) and the Glasgow Edinburgh Throat Scale, before thyroidectomy and at 1, 6, and 12 months postoperatively.
RESULTS: In this study, 14-83% of the patients developed some element of voice and throat dysfunction, shown consistently in different evaluations. Typical patterns were alterations of perceptive voice, deranged acoustic parameters, and subjective worsening on the VHI and GETS. Moreover, these changes were correlated with the extent of treatment, especially within 3 months after operation, and often persisted 12 months postoperatively. RIT had no effects on voice outcomes throughout the follow-up.
CONCLUSION: Voice and throat dysfunction are evident after thyroidectomy, more severely after TT than TL. These potential disabilities should be considered carefully to further enhance patients' quality of life.