EP49 – Use of ultrasound in diagnostic evaluation for thyroid disease in unilateral vocal fold paralysis


    Chen, Amy Y1; Villari, Craig R.1; Klein, Adam M.1;
    1 Department of Otolaryngology, Head & Neck Surgery; Emory University; Atlanta, GA, USA


    Background:  Thyroid malignancy is a relatively rare etiology for unilateral true vocal fold paralysis (UTVFP). Thyroid ultrasound is a safe, rapid diagnostic modality that could be used to evaluate the thyroid in patients with UTVFP.

    Objectives:  Highlight the potential benefits of same-day thyroid ultrasound in select patients presenting with UTVFP to reduce delay in diagnosis of thyroid malignancy.

    Methods:  Retrospective chart review of patients presenting to a tertiary-care voice center for evaluation of dysphonia.

    Results:  Four patients presenting for evaluation of dysphonia were diagnosed with UTVFP. All patients presented with cross-sectional computed tomography (CT) imaging that was reportedly negative. Given suspicion for thyroid disease, patients were referred to a head and neck endocrine surgeon to rule out occult thyroid disease.

    Thyroid ultrasound prompted ultrasound-guided fine needle aspirate in each patient; all biopsies were either diagnostic for thyroid malignancy (75%) or suspicious for malignancy (Bethesda diagnostic category V). All patients underwent total thyroidectomy and all were diagnosed with thyroid malignancy.

    Referral to the tertiary-care voice center took 24 days on average; subsequent referral to the head and neck endocrine surgeon added 19.5 days to total 43.5 days of delay in diagnosis from initial contact with the referring physician.

    Discussion:  In these patients, thyroid ultrasound was a superior imaging modality when compared to CT. Same-day thyroid ultrasound patients could reduce delay in diagnosis and also spare the patient an iodine bolus for CT, further reducing potential delay of post-surgical iodine ablation.



    1. Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am. 2004 Feb; 37(1):25-44.
    2. Yeh MW, Bauer AJ, Bernet VA, Ferris RL, Loevner LA, Mandel SJ, Orloff LA, Randolph GW, Steward DL; American Thyroid Association Surgical Affairs Committee Writing Task Force. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015 Jan;25(1):3-14.


Leave a Reply

  • Upcoming Events


    World Congress on Thyroid Cancer 3.5
    June 20 – 22, 2019
    Rome, Italy

    World Congress on Thyroid Cancer 4.0
    July 29 – August 1, 2021
    Boston, Massachusetts


  • WCTC3.5 Steering Committee:


    Rocco Bellatone, Co-Chair
    Celestino Lombardi, Co-Chair
    Gregory W. Randolph, MD
    Bryan McIver, MD
    Jeremy Freeman, MD
    Ian J. Witterick, MD
    Ashok R. Shaha, MD
    Jatin P. Shah, MD