Voice- and swallowing-related symptoms after total thyroidectomy: evidence from a Brazilian national survey
Sintomas relacionados à voz e deglutição após tireoidectomia total: evidências de uma pesquisa nacional brasileira
Ana Flávia de Sales Cândido; Jozemar Pereira dos Santos; Maria Júlia Galindo Soares; Rafaela Ferreira Alves; Leandro Pernambuco
Abstract
Purpose: to estimate the prevalence of voice- and swallowing-related symptoms in women submitted to total thyroidectomy.
Methods: a population-based, observational, cross-sectional, analytical study, based on a Brazilian national survey. A total of 252 women, aged 18 to 58 years, submitted to total thyroidectomy, residing in the five geographical regions of the country participated in the study. All of them answered the version of the Thyroidectomy-Related Voice Questionnaire translated and adapted into Brazilian Portuguese, besides questions on demographic and clinical issues. A descriptive analysis of the categorical and quantitative variables was conducted. The relationship between the total TVQ score and the independent variables was analyzed with the Mann-Whitney and Kruskal-Wallis tests. The significance level used was 5%.
Results: the most prevalent symptoms were, tired voice, after talking for a long time (50%), and dry mouth/thirst (43.3%). The voice-related symptoms were more prevalent than those related to swallowing. The total TVQ score was not related to age group (p=0.141), profession (p=0.213), region of residence (p=0.303), time since surgery (p=0.955), and radiotherapy/radioiodine therapy (p=0.666).
Conclusion: Brazilian women submitted to total thyroidectomy have a high prevalence of voice- and swallowing-related symptoms, the former being predominant.
Keywords
Resumo
Objetivo: estimar a prevalência de sintomas relacionados à voz e deglutição em mulheres submetidas à tireoidectomia total.
Métodos: estudo de base populacional, observacional, transversal e analítico, baseado em um survey nacional brasileiro. Participaram do estudo 252 mulheres submetidas à tireoidectomia total, com idades entre 18 e 58 anos, residentes nas cinco regiões geográficas do país. Todas responderam a versão traduzida e adaptada para o português brasileiro do Thyroidectomy-Related Voice Questionnaire (TVQ), além de questões demográficas e clínicas. Foi realizada análise descritiva das variáveis categóricas e quantitativas. A relação entre escore total do TVQ e variáveis independentes foi analisada por meio dos testes de Mann-Whitney e Kruskal-Wallis. O nível de significância foi de 5%.
Resultados: os sintomas mais prevalentes foram sensação de voz cansada depois de conversar por muito tempo (50%) e percepção de boca seca/sede (43,3%). Sintomas vocais foram mais prevalentes que os relacionados à deglutição. O escore total do TVQ não se relacionou com faixa etária (p=0,141), profissão (p=0,213), região de residência (p=0,303), tempo de cirurgia (p=0,955) e radioterapia/radioiodoterapia (p=0,666).
Conclusão: mulheres brasileiras submetidas à tireoidectomia total possuem alta prevalência de sintomas relacionados à voz e deglutição, com predomínio dos sintomas vocais seguidos dos sintomas relacionados à deglutição.
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Referências
1. Grover G, Sadler GP, Mihai R. Morbidity after thyroid surgery: patient perspective. Laryngoscope. 2013;123(9):2319-23.
2. Kletzien H, Macdonald CL, Orne J, Francis DO, Leverson G, Wendt E et al. Comparison between patient-perceived voice changes and quantitative voice measures in the first postoperative year after thyroidectomy: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2018;144(11):995-1003.
3. Olson E, Wintheiser G, Wolfe KM, Droessler J, Silberstein PT. Epidemiology of thyroid cancer: a review of the National Cancer Database, 2000-2013. Cureus. 2019;11(2): e4127.
4. Borges AKM, Ferreira JD, Koifman S, Koifman RJ. Thyroid cancer in Brazil: a descriptive study of cases held on hospital-based cancer registries, 2000-2016. Epidemiol. Serv. Saúde. 2020;29(4):e2019503.
5. Janovsky CCPS, Bittencourt MS, Novais MAPD, Maciel R, Biscolla RPM, Zucchi P. Thyroid cancer burden and economic impact on the Brazilian Public Health System. Arch. Endocrinol. Metab. 2018;62(5):537-44.
6. Nam IC, Bae JS, Shim MR, Hwang YS, Kim MS, Sun D Il. The importance of preoperative laryngeal examination before thyroidectomy and the usefulness of a voice questionnaire in screening. World J Surg. 2012;36(2):303-9.
7. Park JO, Bae JS, Chae BJ, Kim CS, Nam IC, Chun BJ et al. How can we screen voice problems effectively in patients undergoing thyroid surgery? Thyroid. 2013;23(11):1437-44.
8. Sahli Z, Canner JK, Najjar O, Schneider EB, Prescott JD, Russell JO et al. Association between age and patient-reported changes in voice and swallowing after thyroidectomy. Laryngoscope. 2019;129(2):519-24.
9. Banach R, Bartès B, Farnell K, Rimmele H, Shey J, Singer S et al. Results of the Thyroid Cancer Alliance International Patient/Survivor Survey: psychosocial/ informational support needs, treatment side effects and international differences in care. Hormones (Athens). 2013;12(3):428-38.
10. Galluzzi F, Garavello W. Dysphagia following uncomplicated thyroidectomy: a systematic review. Eur Arch Otorhinolaryngol. 2019;276(10):2661-71.
11. Martins NMDS, Novalo-Goto ES, Diz-Leme ICM, Goulart T, Ranzatti RP, Leite AKN et al. Patient perception of swallowing after thyroidectomy in the absence of laryngeal nerve injury. ORL J Otorhinolaryngol Relat Spec. 2020;82(5):274-84.
12. Nam IC, Park YH. Pharyngolaryngeal symptoms associated with thyroid disease. Curr Opin Otolaryngol Head Neck Surg. 2017;25(6):469-74.
13. Nam IC, Cho YJ, Bae JS, Lee SH, Park JO, Shim MR et al. Female sex, central lymph node metastasis and dissection are causes of globus symptom after thyroidectomy. Eur Arch Oto-Rhino-Laryngology. 2016;273(6):1607-13.
14. Lee JS, Kim JP, Ryu JS, Woo SH. Effect of wound massage on neck discomfort and voice changes after thyroidectomy. Surg (United States). 2018;164(5):965-71.
15. Iyomasa RM, Tagliarini JV, Rodrigues SA, Tavares ELM, Martins RHG. Laryngeal and vocal alterations after thyroidectomy. Braz J Otorhinolaryngol. 2019;85(1):3-10.
16. Park KN, Mok JO, Chung CH, Lee SW. Does postthyroidectomy syndrome really exist following thyroidectomy? Prospective comparative analysis of open vs. endoscopic thyroidectomy. Clin Exp Otorhinolaryngol. 2015;8(1):76-80. --- PAGE 8 --- Rev. CEFAC. 2021;23(3):e13920 | DOI: 10.1590/1982-0216/202123313920 8/9 | Cândido AFS, Santos JP , Soares MJG, Alves RF , Pernambuco L
17. Araújo LF, Lopes LW, Silva POC, Perrusi VJF, Farias VL de L, Azevedo EHM. Sensory symptoms in patients undergoing thyroidectomy. Codas. 2017;29(3):10-5.
18. Silva IC, Netto IDP, Vartanian JG, Kowalski LP, Angelis ECD. Prevalence of upper aerodigestive symptoms in patients who underwent thyroidectomy with and without the use of intraoperative laryngeal nerve monitoring. Thyroid. 2012;22(8):814-9.
19. Costa BOID, Rodrigues DSB, Magalhães DDD, Santos AS, Santos RV, Azevedo EHM et al. Quantitative Ultrasound Assessment of hyoid bone displacement during swallowing following thyroidectomy. Dysphagia. In Press 2020.
20. Senise AT, Queija DS, Degani C, Corrêa LAC, Dedivitis RA, Lehn CL et al. Sintomas e sinais de alterações da deglutição após a tireoidectomia. Rev bras cir cabeça pescoço. 2009;38(2):67-71.
21. Koga MRV, Soares VMN, Lacerda ABM. Caracterização de pacientes e dos distúrbios de comunicação associados às patologias da tireoide. Tuiuti: Ciência e Cultura. 2013;4(47):91-105.
22. Kuhn MA, Bloom G, Myssiorek D. Patient perspectives on dysphonia after thyroidectomy for thyroid cancer. J Voice. 2013;27(1):111-4.
23. Park YM, Oh KH, Cho JG, Baek SK, Kwon SY, Jung KY et al. Changes in voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study. Ann Otol Rhinol Laryngol. 2018;127(3):171-7.
24. Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A. Prevalence of long-term upper aero-digestive symptoms after uncomplicated bilateral thyroidectomy. Surgery. 2003;133(3):318-22.
25. Hwang YS, Shim MR, Kim GJ, Lee DH, Nam IC, Park JO et al. Development and validation of the Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ). J Voice. In Press 2020.
26. Kim SY, Park JO, Bae JS, Lee SH, Hwang YS, Shim MR et al. How can we predict the recovery from pitch lowering after thyroidectomy? World J Surg. In Press 2020.
27. Chun BJ, Bae JS, Chae BJ, Park JO, Nam IC, Kim CS et al. The therapeutic decision making of the unilateral vocal cord palsy after thyroidectomy using Thyroidectomy-related Voice Questionnaire (TVQ). Eur Arch Oto-Rhino-Laryngology. 2015;272(3):727-36.
28. Kim CS, Park JO, Bae JS, Lee SH, Joo YH, Park YH et al. Long-lasting voice-related symptoms in patients without vocal cord palsy after thyroidectomy. World J Surg. 2018;42(7):2109-16.
29. Choi YS, Joo YH, Park YH, Kim SY, Sun D Il. Factors predicting the recovery of unilateral vocal fold paralysis after thyroidectomy. World J Surg. 2018;42(7):2117-22.
30. Santos DHN, Soares JFR, Ugulino ACDN, Pernambuco L. Translation and cross-cultural adaptation of the Thyroidectomy-Related Voice Questionnaire (TVQ) to Brazilian Portuguese. CoDAS. 2020;32(5):1-7.
31. Instituto Nacional do Câncer. Câncer de tireoide [accessed on 2020 Dec 7]. Available at: https:// www.inca.gov.br/numeros-de-cancer
32. Ryu J, Ryu YM, Jung YS, Kim SJ, Lee YJ, Lee EK et al. Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery. 2013;154(3):611-20.
33. Brasil, Ministério da Saúde. Banco de dados do Sistema Único de Saúde-DATASUS. [accessed on 2020 Dec 7] DATASUS. tabnet.datasus.gov.br/ tabnet/tabnet.htm. Available at: http://www.datasus. gov.br.
34. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
35. Solomon NP. Vocal fatigue and its relation to vocal hyperfunction. Int J Speech-Language Pathol. 2008;10(4):254-66.
36. Chun BJ, Bae JS, Chae BJ, Hwang YS, Shim MR, Sun D Il. Early postoperative vocal function evaluation after thyroidectomy using thyroidectomy related voice questionnaire. World J Surg. 2012;36(10):2503-8.
37. Hong KH, Yang YS, Lee HD, Yoon YS, Hong YT. The effect of total thyroidectomy on the speech production. Clin Exp Otorhinolaryngol. 2015;8(2):155-60. --- PAGE 9 --- DOI: 10.1590/1982-0216/202123313920 | Rev. CEFAC. 2021;23(3):e13920 Voice and swallowing after thyroidectomy | 9/9
38. Cruz JSDSD, Lopes LW, Alves GADS, Rodrigues DDSB, Souza DXD, Costa BID et al. Combined frequency of patient-reported swallowing and voice complaints before thyroidectomy. Audiol - Commun Res. 2019;24:e2180.
39. Monasterios FML, Llabrés XR. Etiopatogenia y diagnóstico de la boca seca. Av Odontoestomatol. 2014;30(3):121-8.
40. Syed YA, Reddy BS, Ramamurthy TK, Rajendra K, Nerella NK, Krishnan M et al. Estimation of salivary parameters among autoimmune thyroiditis patients. J Clin Diagn Res. 2017;11(7):ZC01-ZC04. %
Submetido em:
08/12/2020
Aceito em:
15/01/2021
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