Background: The quoted risk of morbidity after thyroidectomy is based on published data from large series but patients perception remains insufficiently explored.
Methods: A standardized questionnaire was mailed to 312 patients who underwent thyroid surgery in a large university hospital between Jan2008Dec2010.
Results: Replies were received from 202(64%) patients (56M:166F, age 55±16 yrs) at median 23 months after lobectomy (n=112) or total thyroidectomy (n=90) for benign (n=160) or malignant (n=52) conditions. Their present voice was described using a visual analogue scale as normal by 156(89%) patients, mildly impaired (score 34) in 27 patients and moderately/severely impaired in 16 patients. Voice Handicap Index score was normal (score 10) in 126(62%) patients and increased to a median of 17 (range 1129) in 76(38%) patients. As a consequence Voice-Related-Quality-of-Life score was excellent in 107(53%) patients, fair-to-good (score 1115) in 66 patients and poor-to-fair (score 1638) in 30(15%) patients. Patients with more severe voice changes (VHI score >20) had heavier/larger (median 94 vs 76 g, 45 vs. 34 mm) thyroids. Swallowing was reported as normal in 80 patients, moderately affected (score 1115) in 60 patients and severely affected (score 1640, median 23). Calcium supplements prescribed routinely after total thyroidectomy were interrupted within 4 weeks in 54(74%) patients and within 6 months in 23 patients. Appearance of the scar assessed using the Manchester scar score ranged from 516 (median 7). Asked whether they would consider robotic thyroid surgery in order to avoid a cervical scar 38 patients declared to be definitely interested, 40 patients thought this as unlikely, 17 responded with definite No and the majority (106 patients) responded maybe.
Conclusion: On direct questioning a significant proportion of patients report persistent moderate voice and swallowing problems after thyroid surgery. These findings are similar to the recent international multicentre survey of 2900 patients with thyroid cancer.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.