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The Perioperative Management of the Voice and Serum Calcium Levels

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Management of Thyroid Nodules and Differentiated Thyroid Cancer

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Abstract

The complications of laryngeal nerve injury and hypoparathyroidism are relatively uncommon with thyroid surgery. Injury to the recurrent laryngeal nerve results in a hoarse voice, while injury to the external branch of the laryngeal nerve can result in loss of high-pitched vocal range or projection. Neuropraxia, or stretch injury, to the recurrent laryngeal nerve is often transient and will recover over 2–3 months following surgery. Laryngoscopy is the gold standard for diagnosis of vocal cord abnormalities after thyroidectomy. Treatment of vocal cord dysfunction includes voice therapy and operative approaches that aimed at medialization of the paralyzed cord so as to improve adduction and apposition of the vocal cords during phonation which results in more normal voice. Injury or removal of the parathyroid glands during thyroidectomy can result in hypoparathyroidism causing subsequent hypocalcemia. The initial symptoms of hypocalcemia include paresthesias of the extremities, and perioral area can progress to tetany, seizures, and arrhythmias in severe cases. Postoperative supplementation with calcium with or without vitamin D is used in the treatment of hypocalcemia and as prophylaxis against the development of symptoms during inadequate parathyroid hormone production. Routine calcium and vitamin D supplementation or supplementation based on postoperative calcium or parathyroid hormone (PTH) levels are both viable options. Temporary hypoparathyroidism occurs in about a third of patients after bilateral thyroidectomy; however, permanent hypoparathyroidism is rare.

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Author information

Authors and Affiliations

  1. Division of Endocrine Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    David T. Hughes MD & Paul G. Gauger MD

  2. University of Michigan Hospitals and Health Centers, 2920 Taubman Center, SPC 5331, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5331, USA

    David T. Hughes MD

Authors
  1. David T. Hughes MD
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  2. Paul G. Gauger MD
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Correspondence to David T. Hughes MD .

Editor information

Editors and Affiliations

  1. Endocrine Surgery, Department of Surgery, Duke University Medical Center Duke Cancer Institute, Durham, North Carolina, USA

    Sanziana A. Roman

  2. Department of Surgery, Duke University Medical Center Duke Cancer Institute, Durham, North Carolina, USA

    Julie Ann Sosa

  3. Division of Surgical Oncology and Endocrine Surgery, Vanderbilt Endocrine Surgery Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Carmen C. Solórzano

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Hughes, D.T., Gauger, P.G. (2017). The Perioperative Management of the Voice and Serum Calcium Levels. In: Roman, S., Sosa, J., Solórzano, C. (eds) Management of Thyroid Nodules and Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43618-0_19

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  • DOI: https://doi.org/10.1007/978-3-319-43618-0_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43616-6

  • Online ISBN: 978-3-319-43618-0

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