Case Study

Lost for Words – Bilateral Vocal Cord Paresis following Renal Dialysis of a Thyroidectomy Patient

Laurence Gluch
a:1:{s:5:"en_US";s:16:"Concord Hospital";}
* Corresponding author
Deepali Poels
Concord Hospital
DOI icon 10.24018/clinicmed.2023.4.4.304

Read Counter
270

Downloads
164

Citations

Share

Article Sidebar

Submitted 2023-07-22
Published 2023-08-31

Read counter = 270 times

Table of Contents

Article Main Content

A patient underwent a total thyroidectomy for a small papillary thyroid cancer.  Her vocal cord function was assessed as being normal post-operatively.  A week later she underwent her first veno-venous renal dialysis for deteriorating renal function during the post-operative period.  Within 48 hours she had developed bilateral vocal cord paresis, presumed to be on the basis of bilateral recurrent laryngeal nerve oedema precipitated by massive fluid shifts in the fresh surgical bed.  Her voice recovered over the subsequent days as her fluid balance normalized.

Keywords: Recurrent laryngeal nerve renal dialysis vocal cord palsy

References

  1. Papachristos AJ, Glover A, Sywak M, Sidhu SB. Thyroidectomy in Australia 2022: lessons from 21,000 consecutive cases. ANZ J Surg. 2022; 92:1626-30.
     Google Scholar
  2. Sarkis LM, Zaidi N, Norlen O, Delbridge LW, Sywak MS, Sidhu SB. Bilateral recurrent laryngeal nerve injury in a specialized thyroid surgery unit: would routine intraoperative neuromonitoring alter outcomes? ANZ J Surg. 2017; 87:364-7.
     Google Scholar
  3. Akhtar S. Diseases of the Endocrine System. Anesthesia and Uncommon Diseases: Elsevier, 2012; 401-32.
     Google Scholar
  4. Janssen MJ, van der Meulen J. The bleeding risk in chronic haemodialysis: preventive strategies in high-risk patients. Neth J Med. 1996; 48:198-207.
     Google Scholar
  5. Ori Y, Sabo R, Binder Y, et al. Effect of Hemodialysis on the Thickness of Vocal Folds: A Possible Explanation for Postdialysis Hoarseness. Nephron Clinical Practice. 2006; 103:c144-c8.
     Google Scholar
  6. Murt A, Dincer MT, Karaca C, Trabulus S, Altiparmak MR, Seyahi N. Temporary vocal cord paralysis following hemodialysis catheter placement. Hemodial Int. 2020; 24:E20-E2.
     Google Scholar
  7. Pamukcu Gunaydin G, Guru S, Aslan Tas E, Tanriverdi F, Kurtoglu Celik G. Transient vocal cord paralysis following central venous hemodialysis catheter insertion. Am J Emerg Med. 2017; 35:1790 e1- e2.
     Google Scholar
  8. Watanabe K, Hagiya K, Inomata S, Miyabe M, Tanaka M, Mizutani T. Bilateral vocal cord paralysis in a patient with chronic renal failure associated with Alport syndrome. J Anesth. 2010; 24:472-5.
     Google Scholar
  9. Flores-Suarez LF, Alba MA, Tona G. Severe microscopic polyangiitis with unilateral vocal cord paralysis as initial manifestation. Colomb Med (Cali). 2017; 48:32-4.
     Google Scholar
  10. Fernandez de Canete J, Del Saz Huang P. First-principles modeling of fluid and solute exchange in the human during normal and hemodialysis conditions. Comput Biol Med. 2010; 40:740-50.
     Google Scholar
  11. Irefin SA. DIALYSIS 101: Acute and Chronic Fluid Shifts. Anesthesiology Clinics of North America. 2000; 18:853-62.
     Google Scholar
  12. Chen H, Wu B, Gong D, Liu Z. Fluid overload at start of continuous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combined use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement. Crit Care. 2015; 19:135.
     Google Scholar
  13. Wirawan C, Sumada IK, Yuliani D, Wiratmi NKC, Sukiandra R. Dialysis Disequilibrium Syndrome Induced Seizure Following Hemodialysis. Cureus. 2021; 13:e17821.
     Google Scholar