DR DIVYA VASIREDDY,DR NANDITHA GUDI,DR NIKITHA M,DR PRASNA S,DR S S DR S.S DIVYA PRIYA,DR. ISHWARYA DHEVI
DOI: https://doi.org/Introduction
Thyroid surgery, recurrent laryngeal nerve, laryngeal branches, vocal cord palsyThe study's aims are to determine modifiable risk factors, classify patients according to thyroid pathology, and propose surgical decision-making for decreased morbidity secondary to RLN injury.
Material and Methods
This was a prospective observational study carried out at a department of General Surgery of a tertiary care teaching hospital in India for 18 months, from January 2024 to June 2025. Patients of either sex 18 years of age or older scheduled for total thyroidectomy for different thyroid lesions were included in the study. Inclusion criteria were patients looked-forward to being benign or malignant thyroid disease clinically or radiologically which needs total thyroidectomy. Patients who had previously undergone thyroid or neck surgery, those undergoing hemithyroidectomy or subtotal thyroidectomy, and those with preoperative vocal cord palsy were excluded to avoid confounding factors.
Results
This was a prospective observational study of 120 patients undergoing total thyroidectomy, and a strong relationship was seen between thyroiditis and recurrent laryngeal nerve (RLN) injury. Of 46 patients with history-pathologically proven thyroiditis, 10(21.7%) developed RLN injury, whereas only 4(5.4%) of 74 without thyroiditis developed RLN injury. This percentage difference was also statistically significant (p = 0.012) and highlights the fact that thyroiditis significantly increases the risk of RLN injury in thyroidectomy. It is noteworthy that temporary RLN palsy was observed more frequently in the thyroiditis group (15.2% vs. 4.0%, p = 0.045), while the permanent RLN palsy rate was higher, albeit without statistical significance (6.5% vs. 1.4%; p = 0.176), possibly result of relatively small number of subjects.
Significantly longer surgical time was noted in the thyroiditis (mean, 112.3 ± 14.7 minutes) group compared with the non-thyroiditis group (93.4 ± 12.1 minutes) with a p-value, <0.001.
Conclusion
This analysis provides evidence of the significant association between thyroiditis and higher risk for recurrent laryngeal nerve (RLN) injury in patients treated with total thyroidectomy.
