Post-thyroidectomy Vocal Cord Paralysis Along With Hypocalcemia: STROBE - Guided Prospective Cohort
Post-thyroidectomy Vocal Cord Paralysis Along With Hypocalcemia: STROBE - Guided Prospective Cohort
In the present study, the severity of recurrent laryngeal nerve injury (RLNI) and
 hypocalcemia (H) will be followed-up and the probable interrelation between them will be
 proposed considering the clinical situation of patients, e.g. improvement in hypocalcemia
 also make a positive effect on voice? (any objective sign? Ca? PTH?), return of voice is
 parallel with the improvement in hypocalcemia? Postoperative calcium (Ca), parathyroid
 hormone (PTH), regular vocal cord evaluations by ear-nose-throat (ENT) exams,
 deterioration-stability-improvement of clinical symptoms regarding both Ca metabolism and
 vocal cord function will be noted at regular intervals (postoperative day 1-3-first, weekly
 control/first month, monthly/first 6-month, 3-monthly/6-12 months) at outpatient controls.
 Serum Ca, PTH, ENT evaluation of vocal cords-noted.
Total thyroidectomy is currently the preferred surgical treatment modality for both thyroid
 carcinomas and benign disorders such as multinodular goitre, since it minimizes the risk of
 recurrence and eliminates the complication risks of repeat or completion surgery. Vocal cord
 paralysis due to injury to recurrent laryngeal nerve (RLN) is the most dreaded complication
 of total thyroidectomy. The reported incidence of temporary RLN injury (RLNI) varies between
 0 and 12 %, while the incidence of permanent RLNI has been reported to be much lower (0-3.5
 %). In case of bilateral RLNI, respiratory distress and aspiration can develop rapidly and
 may result in mortality. Therefore, all precautions including close monitoring and
 tracheostomy should be undertaken without any delay. The best known technique to avoid injury
 to RLN is meticulous dissection of the nerve throughout its anatomic pathway. However,
 functional impairment of RLN is not visible macroscopically and intraoperative nerve
 monitoring (IONM) has been developed to monitor the nerve to avoid unnecessary dissection.
 Meticulous hemostasis can be achieved with harmonic sealing instrument, since improper
 hemostasis is known to increase the risk of RLNI. Despite the lack of evidence to support an
 advantage of IONM over the standard anatomic dissection of RLN, surgeons have adopted it in
 increasing ratios. The second most feared compliation of thyroidectomy is iatrogenic
 hypocalcemia. Transient symptomatic hypocalcemia after total thyroidectomy occurs in
 approximately 7% to 25% of cases, but permanent hypocalcemia is less common (0.4% to 13.8%).
 Size and invasion of tumor, operative trauma and vascular compromise determines the severity
 of symptoms.
Inclusion Criteria:

 -  Patients with total thyroidectomy indication, for either benign (e.g. multinodular
 goitre) or malign (e.g. thyroid carcinoma) thyroid disease

 -  >17 year-old

 -  Available for close follow-ups at outpatient clinic

 -  Available for close vocal cord exams

 Exclusion Criteria:

 -  Patients with recurrent thyroid disease (benign/malign), prepared for a second
 operation

 -  Preferance of thyroid surgery other than total thyroidectomy