Pharyngolaryngeal reflux simulating vocal fold paralysis hoarsenessfollowing total thyroidectomy
Sara Ramalho, Eugénia Castro, Leandro Ribeiro, Nuno Barros Lima, Artur CondéCentro Hospitalar Vila Nova de Gaia/Espinho
OBJECTIVE
Recognize potential “rare” cause of horseness following thyroid surgery
• 69 year old man• History of Systemic Multifocal Firosclerosis (with Riedel
thyroiditis) total thyroidectomy in February 2011
• Presented to ENT with hoarseness and aspiration episodes few days after total thyroidectomy
• Reflux Symptom Index (Koufman): 30
CASE REPORT
• Endoscopic laryngoscopy: exuberant pharyngolaryngeal reflux with consequent oedema and redundancy of arytenoid mucosa. Simetric mobility of the vocal folds.
• Reflux findig score (Koufman): 15
• Upper GI endoscopy: Inflammation of the esophagus suggesting gastroesophageal reflux and gastritis
Treatment:• Reflux diet• PPI 2id
Six month after treatment:
•Reduction of hoarseness and aspiration episodes
•Endoscopic laryngoloscopy: reduction of pharyngolaryngeal oedema and redundancy of arytenoids
•Reflux findig score (Koufman): 8
• The worsening dysphonia after total thyroidectomy leads to suspicion of iatrogenic vocal fold paresis
• The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage reveals an insuspected cause of hoarseness
• The authors postulate that post-operatory changes in esophagic sphincter pressure may have triggered reflux
Figure 1 and 2 – laryngoscopy before treatment
Figure 3 and 4 – laryngoscopy six month after treatment
REFERENCES:
•Ozgen A, Cila A, Riedel’s thyroiditis in multifocal fibrosclerosis: CT and MR imaging findings, AJNR Am Neuroradiol 2000 Feb; 21(2):320-1; •Hennessey JV, Clinical review: Riedel’s thyroiditis: a clinical review. J Clin Endocrinol Metab 2011 Oct; 96(10):3031-41; •Cho MH, Kim CS, Park JS et al, Riedel’s thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature, Endocr J 2007 Aug; 54(4):559-62; •Jamie A. Koufman, Silent Laryngopharyngeal Reflux (LPR): an overview, Voice Institute of New York
