A 48-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma. On postoperative day 1 she reports hoarseness. Flexible nasopharyngolaryngoscopy reveals the left vocal cord in paramedian position with reduced mobility. What is the most appropriate immediate management?

• A Urgent re-exploration and nerve repair within 24 hours
• B Immediate vocal cord medialization with injection laryngoplasty
• C Observation with speech therapy and reassessment at 6 to 12 months ✓
• D High-dose intravenous methylprednisolone for 5 days

Explanation

Postoperative vocal cord paresis or paralysis after thyroidectomy is most commonly due to neuropraxia from traction, edema or thermal injury rather than transection. If the nerve was visualized and preserved intraoperatively, the majority of palsies recover spontaneously within 6 to 12 months. Observation with speech therapy is the standard initial approach. Re-exploration within 24 hours is not indicated unless there is clear evidence of nerve transection or airway compromise. Injection medialization may be considered if recovery does not occur after several months. Steroids have no proven benefit for neuropraxic injury.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.