Year: 2024
Type: article
Study design: Case Report
Abstract: S.J. Poulose: None. M. Pignanelli: None. D. Aqbal: None. G.D. Rothberger: None. Background: Ultrasound-guided fine needle aspiration (FNA) of thyroid nodules is a generally safe diagnostic procedure. Vocal cord paralysis is an extremely rare complication. Six prior cases demonstrating vocal cord paralysis after FNA all had benign cytology and full resolution of symptoms within six months (1-3). Clinical Case: A 69-year-old female presented for a palpable lump in her left neck. Thyroid ultrasound showed a 2.2 cm left thyroid lobe nodule and 1.8 cm left cervical lymph node. Patient underwent FNA via trans-isthmic approach. Cytology confirmed papillary thyroid cancer (PTC) in the nodule and lymph node. Within a few hours after the FNA, she experienced voice hoarseness, neck pain, and dyspnea with talking. Ultrasound imaging obtained the following day showed an anechoic collection at the biopsy site, consistent with a hematoma. Due to persistent symptoms, she underwent flexible laryngoscopy and CT neck, both demonstrating left vocal cord paralysis. Six weeks post-FNA, patient underwent total thyroidectomy with left radical lymph node dissection. Intraoperatively, the left recurrent laryngeal nerve was found to be intact but encased in a dense inflammatory process, without any nerve signaling. Pathology confirmed tall cell variant of PTC; two out of 15 lymph nodes demonstrated metastatic PTC without extranodal extension. Patient was treated with radioactive iodine therapy. Two months post-FNA, patient reported intermittent hoarseness with only slight improvement. Laryngoscopy performed at that time showed sluggish left vocal cord movement with slightly incomplete abduction/adduction. At patient’s subsequent visit 15 months status-post FNA, she continues to report hoarseness, unimproved over the past year. Conclusion: This is the first known case of vocal cord paralysis resulting in hoarseness persisting greater than six months after FNA of a malignant nodule. This case emphasizes bleeding and vocal cord injury as a rare but serious risk of thyroid FNA. References: (1)Hulin SJ, Harris KP. Thyroid fine needle cytology complicated by recurrent laryngeal nerve palsy and unnecessary radical surgery. J Laryngol Otol. 2006 Nov;120(11):970-1. (2)Tomoda C, Takamura Y, Ito Y, Miya A, Miyauchi A. Transient vocal cord paralysis after fine-needle aspiration biopsy of thyroid tumor. Thyroid. 2006 Jul;16(7):697-9. (3)Mahmood ZZ, Brenner A, Carmel NN, Oestreicher-Kedem Y. Vocal fold paralysis following fine needle aspiration of the thyroid gland complicated by a neck hematoma. Radiol and Diagn Imaging. 2017 Jan;1(2):1-3. Monday, June 3, 2024
Source: Journal of the Endocrine Society
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,418
OpenAlex ID: W4409965282