Medical Center Hormony, Vinnytsia, Ukraine.
Kyiv City Endocrinological Center, Kyiv, Ukraine.
J Med Case Rep. 2024 Apr 4;18(1):149. doi: 10.1186/s13256-024-04461-y.
The main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve's function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient's lifetime and the outcome of the disease were also presented.
A 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.
A history of the disease should always be kept in mind when assessing a patient's complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.
声带麻痹（VCP）的主要原因是喉返神经（RLN）的特发性损伤。然而，RLN 路径上的实体瘤也会影响神经的功能。我们报告了一名甲状腺病变患者，由于纵隔主动脉弓区域大块转移瘤（子宫癌）导致 VCP。该报告旨在展示甲状腺病理学中合并肿瘤的意义，以及避免不必要手术时额外诊断方法的重要性。还介绍了患者的生命和疾病的结果。
一名 58 岁的乌克兰女性，声音嘶哑，间歇性干咳，虚弱，被内分泌外科医生收治。甲状腺病理学包括甲状腺功能减退症的迹象，用甲状腺素 112.5µg 治疗，左叶有一个结节。该病变位于叶的后侧面，可能是 RLN 受累的原因。进行了两次细针抽吸活检（FNAB），结果为贝塞斯达分类 2 级。纤维喉镜（FLS）显示左侧声带位于正中位置。排除了特发性、喉和甲状腺引起的 VCP。此外，患者还显示出子宫切除术后、外照射和化疗后的子宫内膜透明细胞癌病史。16 年后发现纵隔转移。进行了胸部 CT 增强扫描。在主动脉弓下方发现了一个大肿瘤。随后，在进行了 4 个化疗疗程后，声音抱怨明显减少。癌症进展导致锁骨上区域出现淋巴结转移。6 个月后，这位 60 岁的患者去世。
在评估患者的主诉时，应始终牢记病史。甲状腺病理学和以前的继发性恶性肿瘤引起的 VCP 可能是由于 RLN 路径上任何部位的转移性肿瘤引起的。这种罕见病例表明了额外检查方法的重要性，这些方法可能避免不必要的甲状腺手术。
