A case of hemi-phrenic nerve palsy after thyroid surgery

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 449-497-Thyroid Neoplasia & Case Reports
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-450
Seul Ki Kim, Jin Kyung Hwang*, So Young Park, Jung Il Son, Sang Ouk Chin, Sang Youl Rhee, Suk Chon, You-Cheol Hwang, In-Kyung Jeong, Seungjoon Oh, Kyu Jeung Ahn, Ho Yeon Chung, Jeong-taek Woo, Sung-Woon Kim and Young Seol Kim
Kyung Hee University School of Medicine, Seoul, South Korea
Background: One of the complications of modified neck dissection to control regional lymph node metastasis in thyroid cancer is phrenic nerve paralysis. In general, patients with postoperative phrenic nerve paralysis have minimal symptoms. We report a case with a 73-year-old female who experienced hemidiaphragm paralysis after thyroid surgery which resulted in severe respiratory symptoms for a considerably long period.

Clinical case: After total thyroidectomy and right modified radical neck dissection two years ago due to papillary thyroid cancer with right cervical lymph node metastasis (T3N1M0), a 73-year-old female complained of dyspnea and orthopnea She was not able to have a deep sleep because of shortness of breath which was aggravated in supine position. Obstructive lung disease was excluded because her pulmonary function test, gastroscopy, echocardiography, coronary computed tomographic angiography revealed no additional findings. Interestingly, however, her chest x-ray findings at two weeks after operation revealed an elevated ipsilateral hemidiaphragm when compared with pre-operative images, and still remained elevated even one year after the surgery. The fluoroscopic “sniff” test during which diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully, showed the paradoxical elevation of the paralyzed hemodiaphragm with inspiration and the rapid descent of the normal hemidiaphragm. She received conservative management with medications such as mucolytics, theophylline, anti-tussive agents. Six months after the diagnosis, her symptoms improved, but the elevation of hemi-diaphragm at the chest X-ray is observed.

Conclusion: In case of the abrupt dyspnea after thyroid surgery, the possibility of diaphragmatic paralysis should be considered. Early diagnosis and active treatment will be able to reduce the duration of illness and improve related symptoms.

Nothing to Disclose: SKK, JKH, SYP, JIS, SOC, SYR, SC, YCH, IKJ, SO, KJA, HYC, JTW, SWK, YSK

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm