Donniacuo A, Mezzedimi C, Viberti F, Salerni L, Mandalà M, Brindisi L
DSMCN University of Siena, Otolaryngology Department, Viale Bracci 16, 53100 Siena, Italy.
Thyroid Surgery Unit, Otolaryngology Department, Viale Bracci 16, 53100 Siena, Italy.
Int J Surg Case Rep. 2025 Jul 11;133:111665. doi: 10.1016/j.ijscr.2025.111665.
Vocal cord paralysis is one of the most fearsome complications following thyroidectomy surgery. It can be unilateral or bilateral and in this case it could cause a life threatening respiratory distress which requires an emergency tracheostomy (1). Literature demonstrates a spontaneous recovery of vocal cord motility is possible in 79-87,5 % of the patients. Huge multinodular goiter that overturn the normal anatomy or an excessive bleeding that obscure the surgical field can make the intraoperative identification on both laryngeal nerves difficult. The tumoral invasion of the nerves following thyroid carcinoma could be a factor as well. For this reason the intra-operative nerve monitoring (IONM) is a great resource in this type of surgery.
We report the case of patient with bilateral laryngeal nerves paralysis after thyroidectomy with two failed extubating attempts which required the transfer to the intensive care unit. Two days after the patient was extubated and taken under O2 therapy. After a more detailed interview with the patient he reported a well-known history of exertional dyspnea which led to the suspect of latent form of Myasthenia gravis started to rise.
The electromyography (EMG) resulted alternated so that the diagnosis of Myasthenia Gravis was confirmed. The patient started a therapy protocol with corticosteroids and Pyridostigmine with progressive improvements of the symptoms.
In the suspect of a MG patient a careful preoperative evaluation as well as an appropriate intra-operative setting is demanded.
声带麻痹是甲状腺切除术后最可怕的并发症之一。它可以是单侧或双侧的，在这种情况下可能会导致危及生命的呼吸窘迫，需要紧急气管切开术（1）。文献表明，79%至87.5%的患者声带运动有可能自发恢复。巨大的多结节性甲状腺肿使正常解剖结构发生改变，或过多的出血使手术视野模糊，会使术中识别双侧喉返神经变得困难。甲状腺癌侵犯神经也可能是一个因素。因此，术中神经监测（IONM）在这类手术中是一项重要的资源。
我们报告一例甲状腺切除术后双侧喉返神经麻痹的患者，两次拔管尝试均失败，需要转入重症监护病房。两天后患者拔管并接受氧气治疗。在对患者进行更详细的询问后，他报告了有劳力性呼吸困难的病史，这使得重症肌无力潜在形式的怀疑开始增加。
肌电图（EMG）结果呈交替性，从而确诊为重症肌无力。患者开始使用皮质类固醇和吡啶斯的明进行治疗方案，症状逐渐改善。
对于怀疑患有重症肌无力的患者，需要进行仔细的术前评估以及适当的术中准备。
