What are the signs of thyroidectomy-related laryngeal nerve injury and its initial management?

• A. Hearing loss is the typical sign and requires immediate ENT surgery.
• B. Shortness of breath is the most common sign and needs no evaluation.
• C. Hoarseness or voice changes may occur; assessment with bedside exam and laryngoscopy if persistent.
• D. Nausea is the only indicator and requires no further evaluation.

Answer: (D)

Hoarseness or other changes in voice are the typical signs after thyroidectomy because the recurrent laryngeal nerve often sustains injury, leading to vocal cord weakness or paralysis. A patient may notice a breathy, weak, or low-volume voice. If both vocal cords are affected, airway obstruction can occur, causing stridor or dyspnea, which is a true emergency.

The initial management centers on safety and proper assessment. Start with a bedside evaluation of the airway and voice quality. If voice changes are present and persist beyond the immediate postoperative period, arrange laryngoscopy to directly visualize vocal cord movement and mobility. This helps confirm the extent of nerve injury and guides further management. Early involvement of an ENT clinician is appropriate. Depending on the degree of injury, management may include voice therapy, observation, or, in more severe cases, surgical options. Nausea is not a sign of laryngeal nerve injury and does not guide this evaluation or management.