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Original Investigation
April 2018

Patient-Reported Dysphagia After ThyroidectomyA Qualitative Study

Author Affiliations
  • 1Department of Communication Sciences and Disorders, University of Wisconsin, Madison
  • 2Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Wisconsin, Madison
  • 3University of Wisconsin School of Medicine and Public Health, Madison
  • 4Qualitative Health Research Consultants, Madison, Wisconsin
  • 5Department of Sociology, Drexel University, Philadelphia, Pennsylvania
  • 6Wisconsin Surgical Outcomes Research Program, Madison
  • 7Department of Surgery, Division of General Surgery, University of Wisconsin, Madison
JAMA Otolaryngol Head Neck Surg. 2018;144(4):342-348. doi:10.1001/jamaoto.2017.3378
Key Points

Question  How common is postthyroidectomy dysphagia, and how is it characterized by patients and by instrumental evaluation during the first postoperative year?

Findings  Of 26 patients surveyed, 80% (n = 20) perceived dysphagia 2 weeks after thyroidectomy; 42% (n = 11) at 6 weeks; and 17% (n = 4) at 6 months after total thyroidectomy. In contrast, few patients (8%; n = 2) had any abnormalities found by clinical assessment or instrumental swallowing evaluation that warranted further follow-up, and these few abnormalities occurred only at the 2-week follow-up, not beyond.

Meaning  Postthyroidectomy swallowing symptoms are common and may persist for months postoperatively; the risk of dysphagia is important to discuss because simple interventions may improve quality-of-life consequences of patient-perceived postthyroidectomy dysphagia.


Importance  It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population.

Objective  Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes.

Design, Setting, and Participants  Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months). Data were collected from an ongoing clinical trial (NCT02138214), and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics. All participants were age 21 to 73 years with a diagnosis of papillary thyroid cancer without cervical or distant metastases and had undergone total thyroidectomy. Exclusion criteria were preexisting vocal fold abnormalities (eg, polyps, nodules), neurological conditions affecting the voice or swallowing ability, and/or development of new-onset vocal fold paresis or paralysis (lasting longer than 6 months) after total thyroidectomy.

Interventions  Total thyroidectomy.

Main Outcomes and Measures  Symptoms of dysphagia and related effects on quality of life elicited through grounded theory analysis of semistructured interviews with patients after thyroidectomy designed to foster an open-ended, patient-driven discussion.

Results  Of the 26 patients included, 69% were women (n = 18); mean (SD) age, 46.4 (14.1) years; mean (SD) tumor diameter 2.2 (1.4) cm. Two weeks after thyroidectomy, 80% of participants (n = 20) reported at least 1 swallowing-related symptom when prompted by the interview cards; during the open interview, 53% of participants (n = 14) volunteered discussion of swallowing-related symptoms unprompted. However, only 8% of participants in this study (n = 2) qualified for a follow-up dysphagia evaluation, indicating that the majority of reported symptoms were subjective in nature. Six weeks and 6 months after thyroidectomy, 42% (n = 11) and 17% (n = 4) of participants, respectively, reported continued swallowing symptoms using the prompts; 12% (n = 3) discussed symptoms without prompting cards at both time points.

Conclusions and Relevance  Swallowing symptoms after thyroidectomy are underreported in the literature. This study revealed that as many as 80% of patients who have thyroidectomy may experience swallowing-related symptoms after surgery, and many develop compensatory strategies to manage or reduce the burden of these symptoms. Considering the large number of individuals who may experience subjective dysphagia, preoperative counseling should include education and management of such symptoms.