Voice Problems after Thyroid Surgery

Tess Thompson



Although there is a mention of surgical treatments in ancient therapies like Ayurveda, surgery was perfected by modern science. It is capable of curing many diseases that were earlier considered to be fatal. The opposite side of the coin is that any allopathic treatment, of which surgery is a part, is not devoid of side effects. Both radiation and surgery often lead to ‘byproduct’ side effects. The problem is that when a surgeon invades the body or when radiation is targeted at the affected organ, there is a likelihood of some harm to neighboring organs.

Chronic stress, inappropriate diet, iodine deficiency and genetic predisposition can affect thyroid health. Apart from an overactive or under-active thyroid, sometimes extra flesh may also accumulate around the gland to form a nodule, or a thyroid condition that may or may not be cancerous.

Voice problems are a potential risk after any type of surgery that is required to address thyroid problems, especially thyroidectomy, which is excision of the thyroid gland. A cartilaginous structure at the top of the trachea, known as larynx, contains elastic vocal cords that are the source of the vocal tone in speech. The vocal cords are a muscular structure joined at one end; just behind the thyroid cartilage (or Adam’s apple) forming a V. The end of the V is located just above the windpipe. The laryngeal nerves that pass behind the thyroid power the vocal cords.

Surgical procedures involve surgical invasion as well as anesthesia. The laryngeal nerves can be harmed during both procedures. The surgeon may inadvertently cut or stretch the nerves or these may be paralyzed during intubation (insertion of a tube in the trachea before thyroidectomy).

Complete examination of the vocal cords is necessary to determine whether surgery is required. Examination may be done simply by using a mirror and a headlight, but a better view is available with a flexible scope. This allows videotaping of the vocal cords that the surgeon can view at leisure to see whether the vocal cords have been totally or partially paralyzed, dislocated or cut.

In case there is a cut, then further corrective surgery called thyroplasty may be required. This involves placement of a pre-shaped plastic block to push the paralyzed nerve. However, if the laryngeal nerve is only stretched, a wait of six months may restore the voice quality. A graphical record of electric currents associated with muscle contractions using electromyograph tests helps to determine whether the muscles are about to recover and have not permanently lost neural input.

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