Chen, Amy Y1
Villari, Craig R.1
; Klein, Adam M.1
1 Department of Otolaryngology, Head & Neck Surgery; Emory University; Atlanta, GA, USA
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.
Highlight the potential benefits of same-day thyroid ultrasound in select patients presenting with UTVFP to reduce delay in diagnosis of thyroid malignancy.
Retrospective chart review of patients presenting to a tertiary-care voice center for evaluation of dysphonia.
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.
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.
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