A meta-analysis of intraoperative neuromonitoring of recurrent laryngeal nerve palsy during thyroid reoperations

Objective To determine if a preoperative dose of intravenous corticosteroids reduces the risk of postoperative recurrent laryngeal nerve palsy and improves subjective voice outcomes among patients undergoing thyroidectomy. Data Sources PubMed, Cochrane database, and EMBASE. Review Methods Randomized controlled trials comparing corticosteroids with placebo on voice outcomes in thyroid surgery were extracted with standardized search criteria. Systematic review and meta-analysis were performed. With random effects models, trial data were pooled to determine the overall rate of recurrent laryngeal nerve palsy as well as secondary outcomes of adverse events, including wound infection and hyperglycemia. Results Four studies with a total of 517 patients met inclusion criteria. The overall rate of recurrent laryngeal nerve palsy was 5.78%. There was no difference in the rate of palsy between the corticosteroid and placebo groups (risk ratio, 0.70; 95% CI, 0.34-1.44). There was also no difference between the groups in regard to wound infection, healing, or hyperglycemia. Conclusions Preoperative corticosteroids do not appear to reduce the risk of recurrent laryngeal nerve palsy following thyroid surgery. There is insufficient evidence to assess its effect on subjective voice outcomes. More robust randomized controlled trials are needed to assess the effectiveness of perioperative steroids in improving voice outcomes after thyroidectomy.

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Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽

10.1024/1023-9332.7.1.20 ◽

2001 ◽

Vol 7 (1) ◽

pp. 20-24 ◽

Cited By ~ 14

Author(s):

Robert ◽

Mariéthoz ◽

Pache ◽

Bertin ◽

Caulfield ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Long Term Results ◽

Graves Disease ◽

Laryngeal Nerve Palsy ◽

Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

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