The first reported case of clicking larynx syndrome complicating thyroidectomy due to papillary thyroid cancer

Abstract

Introduction and importance

When the superior cornu or the top edge of the thyroid cartilage rubs against the hyoid, or when these structures come to rub against the cervical spine, Clicking Larynx Syndrome (CLS) occurs. Which is a very rare disorder in that only less than 20 cases are reported in the literature. Patients seldom ever mention past laryngeal injuries. The cause of the accompanying pain when present is yet unknown. Gold standard management appears to be thyroplastic surgery in which the structures responsible for the clicking sounds are removed or reduction of the size of the large horn of the hyoid bone.

Case presentation

Herein, we present a 42-year-old male patient with a history of papillary thyroid microcarcinoma treated with left thyroidectomy presented with a spontaneous continuous painless clicking noise and abnormal clicking movement of the larynx.

Clinical discussion

CLS is a very rare condition with a very limited number of cases reported worldwide, most reported cases revealed abnormal laryngeal structural anatomy. However, our patient had normal laryngeal structures where multiple diagnostic tools (i.e.: Computed tomography, laryngoscopy) failed to disclose causative abnormality to explain his symptoms, nor literature could reveal any previously reported similar causes or explain the causative relationship between our patient's history of thyroid malignancy or thyroidectomy with his condition.

Conclusion

It is crucial to explain to patients with mild CLS that these clicking noises are safe and to provide them with information on the best possible case-dependent treatments to avoid the usually associated anxiety and psychological stress. Further observations and research are needed to analyze the association between thyroid malignancy, thyroidectomy and CLS.

Highlights

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  CLS is a rare disorder that only less than 20 cases are reported in the literature.

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  CLS Presents when clicking sound originates upon swallowing, movement, palpation or spontaneously.

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  Main causes are displaced superior cornu or short distance between thyroid cartilage and hyoid bone.

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  Swallowing laryngeal Computed Tomography scanning is the gold standard diagnosis.