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Recurrent laryngeal nerve paralysis and delayed presentation of thyroid cancer
Australian and New Zealand Journal of Surgery, 05/04/09

Suliburk JW et al. - Recurrent laryngeal nerve paralysis (RLNP) may be a sign of occult malignancy in the Tubercle of Zuckerkandl. Small tumour size and posterior location on the gland make reliable imaging and FNA difficult. These pts should have a close f/u and reassessment.

Methods

Aim was to confirm if RLNP is a presenting symptom of thyroid malignancy
Data were obtained from the University of Sydney Endocrine Surgical Unit database
Study group: pts presenting with a pre-operative diagnosis of RLNP prior to thyroid surgery in 10 year period 1999 to 2008

Results

During the study period there were 44 thyroidectomies in cases of preoperative RNLP
16 of these pts (36%) had cancer on final pathology with 14 having well differentiated thyroid cancer
In 3 (18%) of these pts the diagnosis was markedly delayed due to associated multinodular goiter
Mean delay in these 3 pts was 7 yrs
Each of these pts had normal neck CT, thyroid nodules of <8 mm on initial imaging and initial benign FNA
In all 3 pts intra-operative findings noted tumour posteriorly at the Tubercle of Zuckerkandl and histopathology confirmed invasion of the nerve by papillary carcinoma

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