Case report and literature review: Horner syndrome subsequent to endoscopic thyroid surgery

Abstract

Background: Horner syndrome (HS), mainly characterized by symptoms including ptosis, miosis, and anhidrosis on the affected face, is a condition that is well documented but rarely reported as a postoperative complication of thyroidectomy, particularly in endoscopic thyroid surgery (ETS). We hereby report a case of HS due to ETS with a brief literature review on this topic.

Case presentation: A 31-year-old female was admitted to our hospital with an unexpected physical examination finding of two thyroid nodules that were hypoechoic, had an irregular shape, and exhibited calcification. Subsequently, the results of a fine-needle aspiration (FNA) biopsy from the thyroid nodules and BRAF^V600E mutation further confirmed the malignancy of these nodules. Thus, total thyroidectomy combined with central lymph node dissection (CLND) by ETS via the bilateral axillo-breast approach was performed on this patient. Histology confirmed the diagnosis of papillary thyroid microcarcinoma (PTMC) concurrent with Hashimoto's thyroiditis (HT). However, this patient developed HS with ptosis in her left eye on postoperative day 3. All symptoms gradually resolved before the 3-month follow-up.

Conclusion: HS subsequent to ETS is a rare complication. Thus, standardized and appropriate operative procedures, as well as subtle manipulation, are essential in preventing and reducing the occurrence of HS. In addition, the early diagnosis and management of this rare complication are also important for a favorable outcome.

Keywords: Complication; Endoscopic thyroid surgery; Horner syndrome; Thyroid; Thyroid cancer.

Fig. 1

a Ultrasound imaging demonstrated a nodule (0.51 × 0.47 × 0.47 cm) that was located at the middle and upper part of the right thyroid gland; b Ultrasound imaging demonstrated a nodule (0.50 × 0.54 × 0.28 cm) that was located at the isthmus of the thyroid

Fig. 2

Microscopic image of PTMC from this patient, HE staining, × 20 magnification

Fig. 3

Microscopic image of HT (Hashimoto’s thyroiditis) from this patient, HE staining, × 10 magnification

Fig. 4

A 31-year-old female patients who underwent ETS, and suffered from ptosis (white arrow) on the 3rd day after the operation

Fig. 5

The intraoperative nerve monitoring equipment. The recurrent laryngeal nerve (black arrow) and voltage fluctuation after electrical stimulation (white arrow)