How common is postthyroidectomy dysphagia, and how is it characterized by patients and by instrumental evaluation during the first postoperative year?
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.
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.
It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population.
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.
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.
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.
Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, Connor NP. Patient-Reported Dysphagia After ThyroidectomyA Qualitative Study. JAMA Otolaryngol Head Neck Surg. Published online March 08, 2018. doi:10.1001/jamaoto.2017.3378
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