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.   References:
    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.


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