# Surgeon unable to do TT due to vocal cord paralysis



## indigovalley (Oct 9, 2015)

I am so glad I found this board. I am hoping someone out there has some info/personal story/insight for me.

I had thyroid surgery last Friday for a single 1 cm cancerous nodule in my right lobe (papillary carcinoma). My lymph nodes were clear. It was supposed to be a total thyroidectomy due to the cancer but when my surgeon checked the right vocal cord nerve during surgery (with a device) he found it was not functioning. He said my surgery had been uneventful--the thyroid had been easy to remove and the nerve was not cut. It likely had been injured somehow during surgery. But due to this he didn't remove other lobe for fear that the left side vocal cord nerve would also be damaged causing bilateral vocal cord paralysis and requiring me to have a tracheotomy. So the left side lobe was left in place.

My recovery has been OK but my voice is very hoarse and I have difficulty swallowing liquids due to the paralysis. He will check me again in a week and a half. If I'm still having trouble I will have the temporary fix (vocal fold medialization) at the end of October. Then we will wait and see if the nerve comes back to life over the next few months. The pathology report post surgery showed that I had two additional micro spots of cancer in the lobe that was removed. I know my surgeon wants to remove the other lobe due to the cancer and said he would do that if the nerve that is not functioning right now comes back to life. Otherwise we will just watch the other lobe with ultrasound. But I'm sure at some point it will need to come out.

My question: Have any of you out there had this happen? How was it handled by your doctor? It's frightening to think that I could be facing the potential of a permanent tracheotomy down the road with the removal of the remaining thyroid lobe. That bothers me more than losing the quality of my voice (and I am a teacher).

I had uterine cancer in 1999 and had a radical hysterectomy with external and internal radiation treatment. That seems like a walk in the park in comparison to all the potential impact this more curable cancer may have on my quality of life from the treatments. My doctor is good--he's done about 400 of these operations with a good success record. I guess it's just one of those things.

Note: I am a 58 year old female diagnosed with Hasimotos at age 18. I have been taking Levothyroxine for 40 years.


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## Andros (Aug 26, 2009)

My goodness; you have had a very very difficult time of it. I am so sorry for this and just want you to know that we all care and maybe someone will read your post that has had the same experience.

Will you have RAI of the remaining thyroid tissue?

Hugs,


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## Octavia (Aug 1, 2011)

Wow, I am so sorry to hear this. :hugs:

Andros' suggestion/question above about doing RAI treatment on the remaining thyroid tissue instead of surgery is certainly worth exploring. Alternatively, if you do end up opting for surgery again, it may be wise to talk to a few different surgeons; perhaps find one who has done thousands of these surgeries with very, very few complications, if possible...and not at a teaching hospital (too big of a risk of inexperienced surgeons performing parts of your surgery).

Your surgeon's "watch and wait" approach to see what happens with your laryngeal nerve is the typical approach when this happens. Please keep us posted.


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## jenny v (May 6, 2012)

Ugh, I'm so sorry that happened to you. I would definitely explore RAI over another surgery, if it's an option.


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## KeepOnGoing (Jan 2, 2013)

I'm sorry you're going through this.

I'm a teacher too, and when I had my completion surgery, I woke up with very little voice. After 3 weeks I felt pressurised to go back to work with a microphone, as I could barely achieve more than a whisper.

The good news is that my voice did come back (mostly!) - the bad news is it took 4 or 5 months. For the first 6-8 weeks there was little discernible improvement and I was wondering if I was going to have to find another, silent, profession. Then, slowly but surely, my voice returned. This coincided with my getting help from a speech therapist, but I can't really tell how much that contributed to my recovery.

So don't despair, your voice could well improve and it's not hopeless just cos you don't feel like you're getting anywhere quite yet. Then you'll have a few more options for what to do about the other lobe.

Meanwhile, it's probably best to rest your voice (something you'll note I definitely failed to do!). I can teach full time now without undue difficulty, although things like parents' evenings do tend to leave me sounding a little faint and feeling a little dizzy. I can't sing - but this is no loss to the world, let's be honest!

Keep us posted...


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## indigovalley (Oct 9, 2015)

Wow, thanks for all the responses. I am only 1 week past my surgery. I do not see my doctor until Oct. 21. If things haven't improved at that time I will have the temp fix. It's very frustrating as I can eat (although I need to be careful) but must take time to drink water or fluids carefully with a straw to prevent choking. My voice is still very hoarse. It's difficult to cough and I am a little short of breath.

Luckily I will be off work next week also and my doctor has ordered vocal rest during this time. I dread returning to my classroom on the 19th. I know it's going to be tough so I'm already thinking ahead of what technology could help the situation. I am hoping that vocal cord just springs back to life over the next few weeks.

I'm not sure if RAI can be done if part of the thyroid remains. That's why I'm worried we will have to do a second surgery and risk bilateral paralysis. I think I have some time (months) though before that decision needs to be made.

I don't know what to think about my doctor. He has done about 350-400 thyroidectomies with only two vocal cord paralysis and one was because he had to cut the cord due to cancer. He uses the nerve ID device that is recommended. I live in an area with many large clinics and medical centers (including the Mayo clinic). The medical center I am at is not Mayo but it's well regarded. I think he feels bad this happened but he can't explain why. He told me the removal of my thyroid was uncomplicated and easy. Guess I am just unlucky...


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## KeepOnGoing (Jan 2, 2013)

It's really early days yet - my doctor basically said he wouldn't do anything until at least 6 months had elapsed, as most people's voices got significantly better on their own given time. I'm surprised your doctor is going ahead with a temporary fix so soon. Things are, however, very different in the US. Have you asked what the effect will be as and when your voice starts to recover naturally?

Can I recommend a portable microphone system? I used one for months - there's an amplifier you wear around your neck and then a microphone to wear on your head. There's also a volume control which I enjoyed greatly - it's very wearing not being able to raise your voice in the classroom. My school actually paid for the kit, as the alternative was my being off work for a whole term at least.

Do you have what we in the UK would call Occupational Health? They work for the employer (in my case, the local council) but their job is to try and make it possible for you to work. They were really helpful.

I wish I'd followed this advice, but don't go back to the classroom until you're fit enough. Teaching is very demanding and you need your wits about you. I found my vocal chord paralysis made me out of breath and I had a dizzy headache by lunchtime which was very strange. I would have been better staying at home for the first 3 weeks or so.

Let us know how you get on.


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## joplin1975 (Jul 21, 2011)

I would also agree that it's early. I appreciate your frustration, but I think time is your best friend.

I also think you are well within your rights to get a second opinion before you do anything else, in terms of medical procedures. Especially if you are close to a place like Mayo.


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## indigovalley (Oct 9, 2015)

Thanks again everyone. I think my doctor wants to do the injection on my vocal cord sooner rather than later as I am a teacher and that will improve my voice, breathlessness, and ability to swallow fluids (even though it's temporary). We are going day by day so I think if I told him I wanted to wait on that procedure he would. He won't do anything permanent for a long time. It's hard when your voice is very hoarse and has a double tone but I know what you are all saying--this is a long process so I just have to be patient.

I think the school will have PA equipment I can use in my classroom. If needed I plan to teach only half days and in the classes that are non-lecture. I think that would help as I won't have to project my voice as much.


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## KeepOnGoing (Jan 2, 2013)

Just wondering how you are doing? Has your voice improved at all? Did you have the prcedure the doctor was offering.

Thinking of you


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## indigovalley (Oct 9, 2015)

I go for injection treatment of my vocal cord on Thursday. The doctor will use Radiesse to "fatten" the vocal cord and move it more to the midline so my good cord can work with it. He will be using the oral technique to fix it--through the mouth with a needle into the cord. I have been told this should improve my voice quite a bit and also my breathing and chance for aspiration of fluids. I have to be off work for the week afterward as the stuff that is injected settles into place. I am also going to be scheduled to see a speech/language pathologist as part of the treatment. My doctor says the injection will need to be repeated in about 3-4 months. Nothing permanent is done for a year.

I took the advice here and purchased from Amazon a small portable speaker with headset to use in my classroom. It certainly does help with volume but the quality of my voice is so gravely and raspy that it's still a strain to talk. By the end of the day I am just exhausted. That is one of the most frustrating things about the malfunctioning vocal cord. Its sinking in more now how much this is affecting my life and work. At least I am doing OK with eating and drinking at this point. It will take time to get the voice back to a reasonable place.

My doctor said we are just going to monitor my lymph nodes and the lobe of my thyroid that remains. I would be willing to bet that if something crops up there we will just use the iodine treatment. I've got to be honest, I don't really want him to do more surgery on my neck. Now he is saying that if the nerve isn't just bruised in some way it's possible I have an atypical RLN and that he may have accidentally cut it during surgery. Don't doctors check for that kind of thing when doing the surgery--even if it's fairly rare?


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## indigovalley (Oct 9, 2015)

I just wanted to post and let anyone reading my story from last year know that my right vocal cord did recover over time. I only had the vocal cord treatment once to help me talk and breathe better until some time had passed. So those of you with a vocal cord paralysis from thyroid surgery don't give up hope! Its possible for the vocal cord to recover after a few months. I was lucky and it came back within a 3 month period. I have a tiny bit of hoarseness occasionally but even that is fading as time goes on.

I have to get an ultrasound in the summer to see if the remaining lobe of my thyroid is still cancer free. At some point it will likely have to be removed and I will run the risk of a paralyzed vocal cord all over again-especially because it will be on the left side where it happens more frequently. At least I will know what to expect if I have to have surgery again.

Everyone here was very helpful to me as I went through that ordeal. Lots of information here and lots of support...


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## WhatHappened (Nov 12, 2015)

Thanks for the update. I was unaware of how critical that nerve was to breathing. Puts a whole new spin on TT.


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