Do Nimodipine and Steroids Influence Recovery Time in Post-Thyroidectomy Recurrent Laryngeal Nerve Paralysis?

How do nimodipine and other factors affect the recovery rate (RR) and time to recovery (TTR) from post thyroidectomy paralysis of the recurrent laryngeal nerves (RLNs)?

BOTTOM LINE

With no other option than to wait and see for post-thyroidectomy RLN paralysis, nimodipine and/or steroid use may be viable options in the postoperative setting.

BACKGROUND: RLN injury is a thyroidectomy complication leading to abnormalities in mobility and atrophy of the vocal folds. There is no definite treatment for RLN paralysis. Some procedures address the position of the vocal folds rather than the motion. The calcium channel blocker nimodipine may improve nerve recovery following injury.

STUDY DESIGN: Retrospective review.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

SYNOPSIS: Researchers identified 197 patients who had undergone thyroid and parathyroid surgeries at a single tertiary hospital between October 2016 and August 2019. RLN paralysis was defined by lack/decreased mobility of the vocal folds postoperatively; recovery achieved before or at six months was considered temporary paralysis. Overall, RLN paralysis rate among these patients was 11.1%, with temporary and permanent paralysis rates of 7.9% and 1.7%, respectively. The mean TTR was 32 days (cases without recovery excluded). Age and intraoperative extra-thyroid extension were independent risk factors for RLN paralysis. In this study, nimodipine administration was decided postoperatively as intent to treat for patients with clinical and/or laryngoscopic vocal fold incompetence evidence. Researchers’ findings showed that factors affecting TTR included tumor size, central lymph node, procedure, loss of signal (LOS), nimodipine use, and steroid use; LOS was the only factor affecting RR and time. Although nimodipine did not reach statistically significant results, authors say its use with steroids might influence TTR but not RR and have a positive effect on RLN recovery. Study limitations included its retrospective nature, small sample size, and smaller number of events.

CITATION: Mohammad R, Huh G, Cha W, Jeong WJ. Recurrent laryngeal nerve paralysis following thyroidectomy: analysis of factors affecting nerve recovery. Laryngoscope. 2022;132:1692–1696.