General Surgeon Performs a Thyroidectomy Resulting in Hoarseness

This case involved a twenty-five-year-old female who developed hoarseness as a result of thyroid surgery. This woman was diagnosed with severe hyperthyroidism, requiring a thyroidectomy. Prior to the procedure, the surgeon explained one of the complications of the surgery as follows, “…you may experience some changes in your voice due to irritation and inflammation in the area but it is positively reversible with time.” Following surgery, the woman experienced difficulties with speaking and was unable to cough up secretions she felt in her throat. A day later, she began to have shortness of breath and fever consistent with pneumonia. The patient was in great distress requiring hospitalization, sedation, and treatment of her pneumonia. The surgeon visited her bedside, stating that he may have injured or severed a nerve during the surgery. He stated that he wanted to schedule her for another surgery to repair the recurrent laryngeal nerve, which was responsible for her symptoms. After her bout with pneumonia, the woman developed other complications in the hospital including an MRSA skin infection that required aggressive therapy. Additionally, she also required a tracheostomy to help with her breathing. At this time, the patient was not well enough to be cleared by the hospital to undergo additional surgery. One month later, she recovered and was able to go in for additional surgery.

Question(s) For Expert Witness

1. Did the surgeon properly explain the complications of thyroid surgery, and does the recurrent laryngeal nerve commonly get injured as a result of thyroid surgery?

Expert Witness Response

The surgeon did not properly explain the complications of a thyroidectomy. Some complications associated with thyroid surgery includes hematoma, seroma, hypocalcemia, nerve injuries (superior and recurrent laryngeal nerves), vocal cord paresis or paralysis, Horner’s syndrome, fistulae, tracheal injury, and esophageal injury. Although this could have been prevented with more care during the surgery, the surgeon did vaguely warn the patient about the voice changes. However, he provided false hope that it would improve. Additionally, he should have assessed the patient’s throat functioning following surgery to prevent further complications such as aspiration pneumonia and other infections. Temporary injury to the recurrent laryngeal nerve occurs in approximately 6 percent of patients undergoing thyroidectomy, while permanent injury only occurs in 1 percent of patients.