EP.WE.852Role of Prophylactic steroids in the prevention of post-thyroidectomy hypocalcaemia and voice dysfunction

Aim Total thyroidectomy, being a common surgical option, for multinodular goitre and selective cases of Graves’ disease, is associated with risks related to temporary hypocalcaemia and vocal quality dysfunction. Dexamethasone, as a steroid, has well-established anti-inflammatory and immune-modulating effects. As researchers continue to understand its pathophysiology on hypocalcaemia and voice quality, we aim to assess the effect of preoperative dexamethasone used to improve hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder. Methods We conducted a single-centre, non-randomised, double-blinded placebo-controlled, parallel-group study with short follow-up in a public sector hospital from January 2014 to December 2019. Patients were equally distributed in two groups to compare the effect of dexamethasone with placebo on hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder Results Out of 192 patients, 36 (18.75) male patients while 156 (81.25) were female. Age range was 18 to 60. Eighteen patients had both low calcium level at 24 hours after the operation and hypocalcemic symptoms, of which 4 remain to have hypocalcaemia on third postoperative day. Forty patients defined as having voice dysfunction at 24 hours after being scored using Voice scale. Of these 40 patients with voice dysfunction, 8 had low calcium level in blood at 24 hours while only 2 of these remained with low calcium level on third postoperative day. 6/8 patients had symptomatic hypocalcaemia on first postoperative day. Conclusions Single-dose dexamethasone, during the preoperative period, is as safe and as effective in improving transient postoperative hypocalcaemia and Temporary vocal quality dysfunction/post-thyroidectomy voice disorder.

Intraoperative Ultrasonographic Assessment of Vocal Cord motion following pediatric thyroidectomy in the Era of COVID-19, a double-blind study

Unilateral vocal cord paralysis (UVCP) is a known complication of thyroid surgery, due to iatrogenic recurrent laryngeal nerve injury, with reported rates of 2-5% in children. The gold standard for assessing vocal cord function in flexible nasendoscopy (FNE) examination, which is considered high-risk for contraction of the COVID-19 virus. Intraoperative ultrasonographic assessment (IUA) of vocal cord function is a non-invasive and relatively simple procedure, performed in a supine position under general anesthesia. Objectives: To evaluate the validity of IUA modality in children undergoing thyroidectomy, and to compare it to the standard FNE. Design: A prospective double-blind study covering 24 months (March 2019-March 2021). Twenty thyroid lobectomies were performed, during 15 surgeries. Vocal cord function was assessed three times: Preoperatively by FNE, intraoperative (IUA) following extubation, and a second FNE on the first post-operative day. Settings: A tertiary pediatric hospital. Results: The overall accuracy of IUA results in our study was 92%. IUA sensitivity, specificity, positive and negative predictive values were 100%, 89%, 33%, and 100% respectively. Patient’s age demonstrated borderline significance (p= 0.08). The resident’s experience was associated with a better correlation between IUA and FNE results (p<0.05). Conclusions: IUA of vocal cord motion has a high accuracy rate for detection of iatrogenic vocal cord paralysis, similar to FNE. It is easily learned by residents, well tolerated by children, and it provides a safe and valid alternative modality while ensuring the safety of the medical staff in treating patients, especially in times of COVID-19 pandemic.