Voice issues after thyroidectomy
June 3, 2019 10:35 AM Subscribe
I had a total thyroidectomy on April 30 due to being hyperthyroid with Graves Disease and nodules. The surgery went well, although it took longer than the surgeon anticipated because one of the lobes was much larger than he realized. More than a month out I still have significant voice issues.
I was diagnosed with Graves Disease in 2014. After ultrasound, radioactive scan and biopsy (benign) they also discovered several nodules, including a very large one in my left lobe. The Graves has been controlled on methimazole, until I finally decided it was time to deal with it permanently and had the surgery in April. The surgeon estimated the surgery would take about two hours but it ended up being more than four. My left lobe was much larger than they could see on the ultrasound (right lobe was 8 grams, left lobe was 91 grams).
I discussed the potential for voice defects from the surgery with the surgeon beforehand and he was frank that if he was forced to make the choice of saving my parathyroid glands or vocal cords he would save the parathyroid (my calcium levels were fine in the hospital so that turned out OK). The anesthesiologist told me they would be using a breathing tube that sounded an alarm if the surgeon got too close to the vocal cords so I'm reasonably sure that due care was taken.
At my follow up the surgeon was a little concerned about the state of my voice, but only said if I was still having problems after three months to come back in to see him and he would do further testing. Basically I'm still quite hoarse, I am unable to project much volume, and I have no upper register at all. My voice cracks when I try. I can't sing in the car, one of life's great joys. At a recent recital I couldn't even muster a weak "Woo!" which was very distressing.
Has anyone had experience with these issues? If I'm still having these problems at this point is it likely they are permanent? Has anyone had symptoms that did end up resolving after more time? Is there anything I can do to increase my chances of improving? Total vocal rest/voice exercises? I've done some Google research but most articles talk about what surgeons can do to reduce vocal cord issues, not what the patient can do after. Any thoughts or advice would be greatly appreciated!
I was diagnosed with Graves Disease in 2014. After ultrasound, radioactive scan and biopsy (benign) they also discovered several nodules, including a very large one in my left lobe. The Graves has been controlled on methimazole, until I finally decided it was time to deal with it permanently and had the surgery in April. The surgeon estimated the surgery would take about two hours but it ended up being more than four. My left lobe was much larger than they could see on the ultrasound (right lobe was 8 grams, left lobe was 91 grams).
I discussed the potential for voice defects from the surgery with the surgeon beforehand and he was frank that if he was forced to make the choice of saving my parathyroid glands or vocal cords he would save the parathyroid (my calcium levels were fine in the hospital so that turned out OK). The anesthesiologist told me they would be using a breathing tube that sounded an alarm if the surgeon got too close to the vocal cords so I'm reasonably sure that due care was taken.
At my follow up the surgeon was a little concerned about the state of my voice, but only said if I was still having problems after three months to come back in to see him and he would do further testing. Basically I'm still quite hoarse, I am unable to project much volume, and I have no upper register at all. My voice cracks when I try. I can't sing in the car, one of life's great joys. At a recent recital I couldn't even muster a weak "Woo!" which was very distressing.
Has anyone had experience with these issues? If I'm still having these problems at this point is it likely they are permanent? Has anyone had symptoms that did end up resolving after more time? Is there anything I can do to increase my chances of improving? Total vocal rest/voice exercises? I've done some Google research but most articles talk about what surgeons can do to reduce vocal cord issues, not what the patient can do after. Any thoughts or advice would be greatly appreciated!
I would go back to your surgeon, and even get a second opinion. I had a partial thyroidectomy two years ago (I had a 4cm tumor and my left node removed completely), and my surgeon was very frank about the possibility of my voice being affected permanently. He said that it was a very unlikely chance, but he had it happen once in his career, so he wanted to make sure that I knew all the risks. He told me that hoarseness was to be expected for a couple of weeks, but at my follow up if I was still experiencing hoarseness after that, it was to be concerning.
Go back to your surgeon immediately (or if you have an endocrinologist, follow up with them for another surgeon recommendation).
posted by alathia at 11:36 AM on June 3, 2019 [1 favorite]
Go back to your surgeon immediately (or if you have an endocrinologist, follow up with them for another surgeon recommendation).
posted by alathia at 11:36 AM on June 3, 2019 [1 favorite]
Best answer: There are four common things that could cause voice issues after thyroidectomy. The first is that the swelling in the entire area impacts on either the voicebox itself or the nerves moving the vocal cords. After a month this is not likely to still be the case. The second is that purely having the tube down your throat has caused some damage. Again after a month this is either not the case or there is something that isn't going to heal by itself. Third is that the surgeon bruised a nerve during surgery. This can take many months to heal and I imagine this is what he's thinking when he says to wait 3 months. This is super common after thyroidectomy, especially in a surgery that was more complex than expected. This could still improve or completely resolve. Last option is that the surgeon thought he didn't cut the nerve but he actually did. This happens sometimes and it is an expected risk of the procedure - it wouldn't mean that your surgeon had necessarily done anything wrong. In this case you won't get function back but their may be surgical options for improving your voice.
I'm a speech and language therapist in the UK and I get a handful of people a year who have this problem. Here I would certainly refer you to our joint ENT/Speech Therapy voice clinic where the ENT consultant is a specialist laryngologist. They look at the movement of the vocal cords in detail and, importantly, would also be the people who would provide either surgical or behavioural management so they know what the possible outcomes look like and can advise what the options are.
I think it's reasonable to ask that someone looks at your vocal cords now. It would be good to rule out some of the possibilities that aren't related to nerve damage. Our service would also provide some voice therapy at this point to help you look after your voice while things are healing and while we wait to see whether your voice recovers.
posted by kadia_a at 12:32 PM on June 3, 2019 [8 favorites]
I'm a speech and language therapist in the UK and I get a handful of people a year who have this problem. Here I would certainly refer you to our joint ENT/Speech Therapy voice clinic where the ENT consultant is a specialist laryngologist. They look at the movement of the vocal cords in detail and, importantly, would also be the people who would provide either surgical or behavioural management so they know what the possible outcomes look like and can advise what the options are.
I think it's reasonable to ask that someone looks at your vocal cords now. It would be good to rule out some of the possibilities that aren't related to nerve damage. Our service would also provide some voice therapy at this point to help you look after your voice while things are healing and while we wait to see whether your voice recovers.
posted by kadia_a at 12:32 PM on June 3, 2019 [8 favorites]
See your doctor again: this sounds a bit beyond reasonable. My voice was hoarse for at least a couple of months after my partial surgery. My voice projects differently now, but not necessarily worse: having a huge blob pushing your trachea to the side might do that.
I had some minor nerve bruising that caused an occasional upper lip twitch, almost like a flehmen response (NB: not actually as extreme as the tapir pictured) for at least six months after surgery. I haven't noticed it in a while.
posted by scruss at 12:52 PM on June 3, 2019
I had some minor nerve bruising that caused an occasional upper lip twitch, almost like a flehmen response (NB: not actually as extreme as the tapir pictured) for at least six months after surgery. I haven't noticed it in a while.
posted by scruss at 12:52 PM on June 3, 2019
I was talking to my singing teacher (who's also a chiropractor and a damn good anatomist) about his experience with students who'd had goiter surgery.
He said that after thyroid surgery, in his experience, a singer needs to take 6 months off and then retrain from the ground up. If the singer is already good at the mechanics of how to breathe and so on, that doesn't change; but their voice will respond differently and their larynx will move differently than it did before the surgery.
posted by Pallas Athena at 1:57 PM on June 4, 2019
He said that after thyroid surgery, in his experience, a singer needs to take 6 months off and then retrain from the ground up. If the singer is already good at the mechanics of how to breathe and so on, that doesn't change; but their voice will respond differently and their larynx will move differently than it did before the surgery.
posted by Pallas Athena at 1:57 PM on June 4, 2019
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posted by AlexiaSky at 11:12 AM on June 3, 2019 [2 favorites]