The impact of voice impairment after thyroidectomy on quality of life. A prospective cohort study

Introduction: To assess the impact of voice and vocal fold changes (VVFC) after thyroidectomy on disease specific quality of life (QoL). Methods: Prospective cohort study (inclusion period: 18 months, ending April-2016) with six months follow-up of patients with nodular goiter undergoing thyroidectomy without vocal fold disease/impairment. VVFC were defined as objective laryngeal abnormalities and a reduced maximum frequency (> five semitones) three weeks after surgery. The VVFC assessments were conducted before, three weeks, and six months after surgery using videostroboscopy, voice range profile, voice handicap index, and other measures. Simultaneously, a disease-specific QoL questionnaire (ThyPRO) was administered, including an additional assessment three months after surgery. Results: Sixty-five patients were included with nine lost to follow-up, leaving 56 patients who completed all examinations. After surgery 8 patients (14%) had VVFC. No difference in QoL was demonstrated between patients with or without VVFC at baseline and three weeks after surgery. However, three months after surgery patients with VVFC had more goiter symptoms, hyper- and hypothyroid symptoms, tiredness, cognitive complaints, impaired daily life, cosmetic complaints (all above: p=0.01), emotional susceptibility (p<0.047), and decreased overall QoL (p=0.001) compared to patients without VVFC. At six months both groups improved in QoL from baseline, but the group with VVFC persisted in having more goiter symptoms (p=0.005), cognitive complaints (p=0.04), and impaired sex-life (p=0.03) than patients without VFC. Discussion: A significant proportion of patients undergoing thyroidectomy have postsurgical VVFC. This is associated to a reduced quality of life. These patients may benefit from vocal rehabilitation after surgery.