PDF(Pubmed)
Abstract：
BACKGROUND: The main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve\'s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient\'s lifetime and the outcome of the disease were also presented.
METHODS: A 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.
CONCLUSIONS: A history of the disease should always be kept in mind when assessing a patient\'s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.
METHODS: A 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.
CONCLUSIONS: A history of the disease should always be kept in mind when assessing a patient\'s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.
摘要：
背景：声带麻痹（VCP）的主要原因是特发性喉返神经（RLN）受损。然而,沿着RLN途径的实体瘤也可以影响神经的功能。我们介绍了一名由于纵隔主动脉弓区的大转移性肿块（子宫癌）而患有甲状腺病变和VCP的患者。该报告旨在显示甲状腺病理中合并症肿瘤的重要性以及其他诊断方法在避免不必要手术中的重要性。还介绍了患者的一生和疾病的结果。
方法：一位58岁的乌克兰妇女，声音嘶哑，间歇性干咳,并向内分泌外科医生提出了弱点。甲状腺病理包括用甲状腺素112.5µg治疗的甲状腺功能减退征象和左叶结节。病变位于肺叶的后部,这可能是RLN参与的原因。进行了两次细针穿刺活检（FNAB），结果为Bethesda2类。纤维喉镜（FLS）显示左声带的正中位置。特发性,喉,VCP的甲状腺病因被排除.此外,患者在子宫切除术后表现出子宫内膜透明细胞癌的病史，外束放射治疗，和化疗。16年后发现纵隔转移。进行了静脉造影的胸部计算机断层扫描（CT）。在主动脉弓下发现了一个巨大的肿瘤。随后，4个疗程的化疗后，声音投诉显着减少。癌症进展导致锁骨上区域出现淋巴结转移。六个月后，这名60岁的患者去世了。
结论：在评估患者的主诉时，应始终牢记病史。在甲状腺病理和先前的继发性恶性肿瘤的情况下，VCP可能是由沿RLN途径的任何地方的转移性肿瘤引起的。这种罕见的情况表明了其他检查方法的重要性，这些检查方法可以避免不必要的甲状腺手术。
方法：一位58岁的乌克兰妇女，声音嘶哑，间歇性干咳,并向内分泌外科医生提出了弱点。甲状腺病理包括用甲状腺素112.5µg治疗的甲状腺功能减退征象和左叶结节。病变位于肺叶的后部,这可能是RLN参与的原因。进行了两次细针穿刺活检（FNAB），结果为Bethesda2类。纤维喉镜（FLS）显示左声带的正中位置。特发性,喉,VCP的甲状腺病因被排除.此外,患者在子宫切除术后表现出子宫内膜透明细胞癌的病史，外束放射治疗，和化疗。16年后发现纵隔转移。进行了静脉造影的胸部计算机断层扫描（CT）。在主动脉弓下发现了一个巨大的肿瘤。随后，4个疗程的化疗后，声音投诉显着减少。癌症进展导致锁骨上区域出现淋巴结转移。六个月后，这名60岁的患者去世了。
结论：在评估患者的主诉时，应始终牢记病史。在甲状腺病理和先前的继发性恶性肿瘤的情况下，VCP可能是由沿RLN途径的任何地方的转移性肿瘤引起的。这种罕见的情况表明了其他检查方法的重要性，这些检查方法可以避免不必要的甲状腺手术。
