Case Discussion:

A 31 year old female consulted because of anterior neck mass that moves with
deglutition. Pertinent PE revealed the following:
BP: 110/80
CR 68
RR 17
T-37 C
An enlarged Thyroid gland with left lobe measuring 6 x 5 cm while the right lobe
measuring 5x5 cm, isthmus was normal in size. Thyroid function test was normal
and US revealed enlarged thyroid gland with multiple subcentimeter non calcificed
nodules on both lobes. She underwent total thyroidectomy. Post operatively, she
was noted to have circum-oral numbness, (+) Chvosteks sign. Se was given IV
calcium gluconate affording relief, she was dscharged after two days and given take
home meds of thyroxine and calcium carbonate. On follow up she complained that
the pitch of her voice is lower and she cannot sing high notes anymore

Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of
the facial nerve. Trousseau's sign is carpopedal spasm caused by inflating the blood-pressure
cuff to a level above systolic pressure for 3 minutesChvostek's sign is the twitching of the facial
muscles in response to tapping over the area of the facial nerve. Trousseau's sign is
carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure
for 3 minutes

A lower-pitched voice is one of the most common voice alterations after thyroidectomy without laryngeal
nerve injury. The aim of this study was to evaluate the acoustic and stroboscopic changes and the
treatment outcomes in patients with a lower-pitched voice with the goal of eventually establishing a
therapeutic guideline.
Normal size
Listing of learning issues