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Respiratory distress is a feared complication after thyroid surgery. Differential diagnosis includes bilateral recurrent laryngeal nerve palsy (BRLNP), local hematoma, vocal cord edema and laryngeal trauma. BRLNP results from intraoperative irritation without physical injury (neurapraxia), or intraoperative partial or complete transsection (axonotmesis and neurotmesis, respectively) of the recurrent laryngeal nerve (RLN). RLN palsy typically manifests immediately in the postoperative course. However, in rare cases there is a delayed, progressive development of BRLNP, potentially leading to respiratory failure in emergency setting weeks after initial surgery. Herein we report on a patient developing massive respiratory distress secondary to BRLNP 5 weeks after thyroidectomy for massive goiter. With the current tendency to decrease the length of hospital stay after thyroid surgery, late onset palsy of the RLN should be included into the differential diagnosis for acute respiratory distress in patients with recent history of thyroid surgery. TOBIAS SCHULZE ( ) CLAUS-DIETER HEIDECKE •

Late manifestation of bilateral laryngeal nerve palsy after thyroidectomy