Pharyngolaryngeal reflux simulating vocal fold paralysis hoarseness following total thyroidectomy Sara Ramalho, Eugénia Castro, Leandro Ribeiro, Nuno Barros Lima, Artur Condé Centro Hospitalar Vila Nova de Gaia/Espinho OBJECTIVE Recognize potential “rare” cause of horseness following thyroid surgery • 69 year old man • History of Systemic Multifocal Firosclerosis (with Riedel thyroiditis) total thyroidectomy in February 2011 • Presented to ENT with hoarseness and aspiration episodes few days after total thyroidectomy • Reflux Symptom Index (Koufman): 30 CASE REPORT • Endoscopic laryngoscopy: exuberant pharyngolaryngeal reflux with consequent oedema and redundancy of arytenoid mucosa. Simetric mobility of the vocal folds. • Reflux findig score (Koufman): 15 • Upper GI endoscopy: Inflammation of the esophagus suggesting gastroesophageal reflux and gastritis Treatment: • Reflux diet • PPI 2id Six month after treatment: •Reduction of hoarseness and aspiration episodes •Endoscopic laryngoloscopy: reduction of pharyngolaryngeal oedema and redundancy of arytenoids •Reflux findig score (Koufman): 8 • The worsening dysphonia after total thyroidectomy leads to suspicion of iatrogenic vocal fold paresis • The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage reveals an insuspected cause of hoarseness • The authors postulate that post-operatory changes in esophagic sphincter pressure may have triggered reflux Figure 1 and 2 – laryngoscopy before treatment Figure 3 and 4 – laryngoscopy six month after treatment REFERENCES: •Ozgen A, Cila A, Riedel’s thyroiditis in multifocal fibrosclerosis: CT and MR imaging findings, AJNR Am Neuroradiol 2000 Feb; 21(2):320-1; •Hennessey JV, Clinical review: Riedel’s thyroiditis: a clinical review. J Clin Endocrinol Metab 2011 Oct; 96(10):3031-41; •Cho MH, Kim CS, Park JS et al, Riedel’s thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature, Endocr J 2007 Aug; 54(4):559-62; •Jamie A. Koufman, Silent Laryngopharyngeal Reflux (LPR): an overview, Voice Institute of New York