良性甲狀腺疾病造成之聲帶麻痺

Vocal Fold Paralysis Occurring Secondary to Benign Thyroid Disease

梁明泰(Ming-Tai Liang) ； 王仲祺(Chen-Chi Wang)

《台灣耳鼻喉頭頸外科雜誌》 41卷2期 (2006/04) Pp. 79-82

https://doi.org/10.6286/2006.41.2.79

摘要

術前合併聲帶麻痺的甲狀腺腫瘤並不常見，尤其是良性的結節性甲狀腺腫更是少見。本部有1名65歲女性及1名61歲男性分別於2004年11月及2005年2月，因聲音嘶啞及前頸部腫塊來院求診。兩者之喉內視鏡檢查皆發現有右側聲帶麻痺的情形，甲狀腺腫瘤之細針穿刺檢查並未發現有惡性細胞，然而術前之影像學檢查都有腫瘤壓迫Tracheo-esophageal groove之跡象。兩名患者相繼住院切除甲狀腺右葉，右側的喉返神經都能於手術中確認並保留，術後病理報告皆為良性的結節性甲狀腺腫。病患出院後定期於門診追蹤聲音品質及聲帶運動功能，男性患者術前有3個月聲帶麻痺病史，於術後3個月恢復聲帶運動；相對地，女性患者術前有兩個月聲帶麻痺病史，術後追蹤7個月仍未恢復。依據文獻記載，對於合併聲帶麻痺之甲狀腺疾病需強烈懷疑惡性腫瘤之存在，術前聲帶麻痺肇因於良性甲狀腺疾病之發生率只有0.7%。因此類病例少見，可提供良性腫瘤壓迫喉返神經造成聲帶麻痺的證據，特此提出報告。

關鍵字

聲帶麻痺 ； 結節性甲狀腺腫

並列摘要

A benign thyroid tumor that is accompanied by pre-operative vocal fold paralysis is unusual. In 1994 and 1995, a 65-year-old female and a 61-year-old male, respectively, were admitted for the symptoms of hoarseness and a thyroid gland mass. Physical examination revealed right vocal fold paralysis in both cases, but no malignancy was found after fine-needle aspiration biopsy of either patient. Right thyroid lobectomy was performed on both patients. The right recurrent laryngeal nerves were all identified and preserved during both operations. The pathological report showed nodular goiter without malignancy. The quality of voice and the mobility of vocal fold of the two patients were then monitored regularly. The male patient had showed hoarseness for 3 months before operation, and vocal fold motility was recovered three months after operation. The female patient had suffered from hoarseness for 2 months before the operation; however, the right vocal fold was still immobile seven months after operation. A study of the literature indicates that there is the incidence of pre-operative vocal fold paralysis among the patients who have benign pathology after thyroidectomy of 0.7%. In the past, it has been suggested that thyroid tumors in association with recurrent laryngeal nerve paralysis need to be considered as having a significant chance of being malignant. Here, we have reported two cases where the occurrence of laryngeal nerve paralysis was caused by compression due to nodular goiter.

並列關鍵字

vocal fold paralysis ； nodular goiter