Patients with medullary thyroid carcinoma (MTC) may be at an increased risk for vocal cord paralysis (VCP), compared to patients with other thyroid malignancies, according to a study published in Laryngoscope. In the study, patients with VCP also appeared to have a higher risk of mortality than other MTC patients did.

VCP was observed in 13 out of the 79 MTC patients (16.5%) included in the study. Twelve out of the 13 patients developed VCP perioperatively with the other patient developing it over 12 years after their initial surgery due to MTC recurrence.

“Our study shows that the incidence of VCP in MTC (16.5%) in our patient population was higher than what has been reported for thyroid malignancies in general,” the authors said.

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Previous studies have estimated a VCP rate of 1% to 4% after thyroidectomy for all indications. Another study focused on well-differentiated thyroid cancers found a rate of 9.5% for papillary thyroid cancer (PTC) and 13.1% for MTC.

Read more about MTC complications.

Of the 79 patients in the study, 71 had at least 1 year of follow-up, with a median of 7.2 years. The patients from this group who experienced VCP within 1 year of surgery had a 7.2 (95% CI, 2.3-22.7) times higher risk of death compared to MTC patients without (P <.0001). The patients with VCP in the study were also more likely to have stage IV cancer compared to those without VCP (58% vs 15%; P <.01).

“[MTC] is associated with an increased risk of perioperative VCP, and VCP has a significant negative impact on survival. Further studies are necessary to elucidate this relationship further and to determine whether VCP is an independent risk factor for decreased survival,” the authors concluded.

The median age of the 79 MTC patients enrolled in the study was 52 years, with the majority of patients being female (n=47; 59.5%). Cancer staging was available for 73 of the patients, with stage III being the most common (38.4%) and stage IV being the second most common (23.2%).


Drozdowski V, Martini D, Charous S. Incidence of vocal cord paralysis in medullary thyroid cancer. Laryngoscope. Published online July 14, 2022. doi:10.1002/lary.30297