Voice alteration is one of the most common complications after thyroidectomy. It has a serious effect on social communication and economic and psychosocial status of patients. It has been hypothesized that inflammation and edema in the surgery site has a major role in voice change after thyroidectomy. This randomized clinical trial study was design to evaluate the effect of a single preoperative dose of steroid on voice change after thyroidectomy. This is a prospective randomized clinical trial with registration no. IRCT201106306925N. From all definitive candidates for total thyroidectomy, eligible patients were selected after exclusion of 12 criteria. Selected cases were randomly allocated to two groups. One group received intravenous dexamethasone pre-operatively. Other group received placebo. Voice change was evaluated by Voice Impairment Score (VIS) postoperatively. Sixty-four patients were entered in the study and divided into two groups (dexamethasone and placebo). VIS was significantly different at the first day after surgery between dexamethasone (five) and controls (13; P < 0.001). This difference was seen after 7 days but without statistically significance (one vs three; P = 0.397). VIS score significantly decreased on the seventh day related to the first day (P < 0.001) in both groups. There were no significant dexamethasone complications in either group. Preoperative dexamethasone may decrease voice change after thyroidectomy.
Get full access to this article
View all access options for this article.
References
1.
LombardiC.P., RaffaelliM., D'AlatriL.Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.Surgery2006; 140: 1026–32; discussion 1032.
2.
LombardiC.P., RaffaelliM., D'alatriL.Video-assisted thyroidectomy significantly reduces the risk of early post-thyroidectomy voice and swallowing symptoms.World J Surg2008; 32: 693–700.
3.
WorniM., SchudelH.H., SeifertE.Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function.Ann Surg2008; 248: 1060–6.
4.
LoC.Y., KwokK.F., YuenP.W.A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.Arch Surg2000; 135: 204–7.
5.
JatzkoG.R., LisborgP.H., MullerM.G.Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review.Surgery1994; 115: 139–44.
6.
NamI.C., BaeJ.S., ShimM.R.The importance of pre-operative laryngeal examination before thyroidectomy and the usefulness of a voice questionnaire in screening.World J Surg2012; 36: 303–9.
7.
LiuQ., DjuricinG., PrinzR.A.Total thyroidectomy for benign thyroid disease.Surgery1998; 123: 2–7.
8.
ChiangF.Y., WangL.F., HuangY.F.Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve.Surgery2005; 137: 342–7.
RazackM.S., LoreJ.M.Jr., LippesH.A.Total thyroidectomy for Graves’ disease.Head Neck1997; 19: 378–83.
11.
AgarwalA., MishraS.K.Role of surgery in the management of Graves’ disease.J Indian Med Assoc2001; 99: 252, 254–6.
12.
SteurerM., PasslerC., DenkD.M.Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk.Laryngoscope2002; 112: 124–33.
13.
FlynnM.B., LyonsK.J., TarterJ.W.Local complications after surgical resection for thyroid carcinoma.Am J Surg1994; 168: 404–407.
14.
JonesK.J., DrenglerS.M., OblingerM.M.Gonadal steroid regulation of growth-associated protein GAP-43 mRNA expression in axotomized hamster facial motor neurons.Neurochem Res1997; 22: 1367–74.
15.
StankiewiczJ.A.A review of the published data on steroids and idiopathic facial paralysis.Otolaryngol Head Neck Surg1987; 97: 481–6.
AustinJ.R., PeskindS.P., AustinS.G.Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone.Laryngoscope1993; 103: 1326–33.
18.
LeeK.J., FeeW.E.Jr., TerrisD.J.The efficacy of corticosteroids in postparotidectomy facial nerve paresis.Laryngoscope2002; 112: 1958–63.
19.
LoreJ.M.Jr., FarrellM., CastilloN.B.Endocrine surgery. In: LoreJ.M.Jr., MedinaJ.E., eds. An Atlas of Head and Neck Surgery, 4th ed.Philadelphia, PA: Elsevier; 2005: 963–5.
20.
WangL-F, LeeK-W, KuoW-RThe efficacy of intraoperative corticosteroids in recurrent laryngeal nerve palsy after thyroid surgery.World J Surg2006; 30: 299–303.
21.
ApfelC.C., BacherA., BiedlerA.A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.Anaesthetist2005; 54: 201–9.
22.
WangJ.J., HoS.T., TzengJ.I.The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting.Anesth Analg2000; 91: 136–9.
23.
WangJ.J., HoS.T., LeeS.C.The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline.Anesth Analg1999; 89: 200–3.
24.
LeeY., LinP.C., LaiH.Y.Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy.Acta Anaesthesiol Sin2001; 39: 151–6.
25.
FerociF., RettoriM., BorrelliA.Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial.Head Neck2011; 33: 840–6.
26.
FujiiY., TanakaH., KobayashiN.Granisetron/dexamethasone combination for the prevention of postoperative nausea and vomiting after thyroidectomy.Anaesth Intensive Care2000; 28: 266–9.
27.
TavlanA., TuncerS., ErolA.Prevention of postoperative nausea and vomiting after thyroidectomy: combined antiemetic treatment with dexamethasone and ginger versus dexamethasone alone.Clin Drug Investig2006; 26: 209–14.
28.
HenziI., WalderB., TramerM.R.Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review.Anesth Analg2000; 90: 186–94.
