sharing sensitive information, make sure youre on a federal The external branch of the superior laryngeal nerve is not exposed routinely. MeSH https://doi.org/10.1007/s00268-008-9837-9, Sabaretnam M, Mishra A, Chand G et al (2012) Assessment of swallowing function impairment in patients with benign goiters and impact of thyroidectomy: a case control study. Please enable it to take advantage of the complete set of features! Number 3099067. They found a decreased pressure in the upper esophageal sphincter in postoperative esophageal manometry by an average of 25% after uncomplicated thyroidectomy, recovering to original values after 2 years.5,17 In case of radical central neck dissection, the inferior laryngeal nerve and the nerve branches destined for esophageal region are dissected; an extended dissection of the nerves could predispose to risk. BMJ. Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study. Lombardi CP, Raffaelli M, DAlatri L, et al. https://doi.org/10.1067/msy.2003.58, Cho JG, Byeon HK, Oh KH et al (2020) Objective assessment of postoperative swallowing difficulty through ultrasound in patients undergoing thyroidectomy. https://doi.org/10.1177/1054773817729074, Martins N, Novalo-Goto ES, Diz-Leme ICM et al (2020) Patient perception of swallowing after thyroidectomy in the absence of laryngeal nerve injury. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). https://doi.org/10.1097/SLE.0000000000000582, Goswami S, Peipert BJ, Mongelli MN et al (2019) Clinical factors associated with worse quality-of-life scores in United States thyroid cancer survivors. Bookshelf Dysphagia after uncomplicated thyroidectomy is commonly reported and it includes a broad spectrum of swallowing complaints. Aging and swallowing. Of the 26 patients included, 69% were women (n = 18); mean (SD) age, 46.4 (14.1) years; mean (SD) tumor diameter 2.2 (1.4) cm. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Patient-Reported Dysphagia After Thyroidectomy - JAMA I put a little green food coloring in the liquid and the puree that just allows us to see it better when the cameras in place. Two weeks after thyroidectomy, 80% of participants (n = 20) reported at least 1 swallowing-related symptom when prompted by the interview cards; during the open interview, 53% of participants (n = 14) volunteered discussion of swallowing-related symptoms unprompted. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). What's the likeliest cause of my symptoms? Diagnosis of dysphagia in thyroidectomy patient should begin with clinical evaluation and confirmed by videfluorocsopy or videoendoscopy. Epub 2022 Apr 19. Epub 2018 Sep 7. DISCHARGE INSTRUCTIONS: Seek care immediately if: You have sudden tingling or muscle cramps in your face, arm, or leg. 2022 Sep;279(9):4213-4227. doi: 10.1007/s00405-022-07386-8. 1976;235(1):5859. In addition, choking decreased from 3 % to 2 %, dyspnea decreased from 9 % to 6 %, and cough decreased from 7 % to 5 %. Vardaxi C, Tsetsos N, Koliastasi A, Poutoglidis A, Sapalidis K, Triaridis S, Printza A. Eur Arch Otorhinolaryngol. The site is secure. Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study Swallowing disorders after thyroidectomy: a systematic - Springer We found that particularly after lymph node dissection and surgical treatment for Graves disease, postoperative dysphagia occurs. Bethesda, MD 20894, Web Policies This injection will help any leftover thyroid tissue absorb the radioactive iodine. Furthermore, we report a foreign body/sticky sensation in the throat as an . Unable to load your collection due to an error, Unable to load your delegates due to an error. Ann Otol Rhinol Laryngol 127(3):171177. That's it. This site needs JavaScript to work properly. Thyroid surgery is one of the most commonly performed endocrine surgical procedures, the risk of complications is high due to the anatomical structure and physiological function of the RLN.. 8600 Rockville Pike Methods: https://www.uptodate.com/contents/search. Curr Opin Otolaryngol Head Neck Surg. Surg Laparosc Endosc Percutan Tech 16(4):226231. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. https://doi.org/10.2147/POR.S172059, Gumus T, Makay O, Eyigor S et al (2020) Objective analysis of swallowing and functional voice outcomes after thyroidectomy: a prospective cohort study. Contact Us Fass R. Approach to the evaluation of dysphagia in adults. Prospective randomized controlled trial on the use of flexible reinforced laryngeal mask airway (LMA) during total thyroidectomy: effects on postoperative laryngopharyngeal symptoms. Patients and methods: A questionnaire was sent to 372 consecutive patients whose thyroid or parathyroid glands were operated on between May 2013 and October 2014 at Ulm University Hospital. https://doi.org/10.1097/SLE.0000000000000743, Lee J, Kwon IS, Bae EH et al (2013) Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. Postoperative swallowing disorder after thyroid and parathyroid resect In the early postoperative weeks after thyroidectomy, swallowing impairment is self-explanatory and is reported by most patients.6 Symptoms are often self-limiting, are not related to impaired nerve function and improve spontaneously. FOIA https://doi.org/10.1258/002221505775010760, Ben Nun A, Soudack M, Best LA (2006) Retrosternal thyroid goiter: 15 years experience. Thyroidectomy is a well-described procedure used to excise the thyroid gland. Greenblatt et al report a significant improvement in postoperative swallowing using the standardized SWAL-QOL questionnaire, designed to find out how swallowing problems affect quality of life.2 With the same questionnaire, Sabaretnam et al8 reported a significant improvement in quality of life in patients with benign goiters after thyroidectomy and Pinchot et al reported a significant improvement in quality of life in patients with parathyroid disease after thyroidectomy.9. Surgery. 2013 Nov;20(12):3869-76. doi: 10.1245/s10434-013-3163-7. A quantitative synthesis of the results followed. https://doi.org/10.1136/bmj.n71, Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. The number of subjects varied from 12 to 254, the mean age from 39 to 54 years with an overall prevalence of females. The type of surgical treatment depends on the cause of dysphagia. https://doi.org/10.1097/00129689-200608000-00006, Yu ST, Chen WZ, Xu DB et al (2019) Minimally invasive video-assisted surgical management for parapharyngeal metastases from papillary thyroid carcinoma: a case series report. A randomized controlled study. For low-risk patients showing an excellent response after treatment, . A speech-language pathologist performing head positioning on a patient. Do you cough or gag when you try to swallow? https://doi.org/10.1002/hed.24409, Chun BJ, Bae JS, Lee SH et al (2015) A prospective randomized controlled trial of the laryngeal mask airway versus the endotracheal intubation in the thyroid surgery: evaluation of postoperative voice, and laryngopharyngeal symptom. 2020; doi:10.1007/s10072-020-04495-2. Arch Otolaryngol Head Neck Surg. 2017 May;41 Suppl 1:S94-S102. doi: 10.7759/cureus.34078. Wentworth MA. Notes: Patients with Graves disease and carcinomas showed a significantly higher risk and patients with hyperparathyroidism a significantly lower risk of dysphagia. A new subfascial approach in open thyroidectomy: efficacy for postoperative voice, sensory, and swallowing symptoms. Swallowing disorders after thyroidectomy: What we know and where we are. Merck Manual Professional Version https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/dysphagia#. Bulk reprints for the pharmaceutical industry. Introduction: Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees. https://doi.org/10.12669/pjms.305.4767, Article Neurological Sciences. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. Grover G, Sadler GP, Mihai R. Morbidity after thyroid surgery: patient perspective. Intubation is also in discussion as a cause of dysphagia,18,19 but Pereira et al report that, after comparing prevalence of dysphagia in patients after cholecystectomy and thyroidectomy, long-term symptoms are not related to orotracheal intubation.4. Prospective comparative analysis of open vs. endoscopic thyroidectomy. Parathyroid surgery was performed without a routine four-gland exploration. The chi-squared test showed no significant relation between operation and dysphagia (thyroidectomy with/without lymph nodes: chi-squared test=3.2/2.7, subtotal resection/hemithyroidectomy: chi-squared test 0.3/2.1, and parathyroid resection: chi-squared test=3.7). J Laryngol Otol 119(12):973975. 2022 May 4;9:882594. doi: 10.3389/fsurg.2022.882594. However the number of parathyroidectomy surgeries is very small (only 33 patients) and results can be influenced by the small number. Dysphagia after thyroidectomy can be best managed with application of conservative treatment, compensatory maneuvers and surgical treatment depending on the cause of dysphagia. government site. Of the 936 articles retrieved, 18 discussed "voice assessment and thyroidectomy", 3 discussed "voice therapy and thyroidectomy", and 11 discussed "surgical interventions for voice restoration after thyroidectomy". A qualitative analysis of data extracted was conducted. The purpose of the current systematic review is to investigate the prevalence of dysphagia at various time points after thyroidectomy, at the whole spectrum of it (total/partial, open/endoscopic, for benign/malignant disease). 2015;72(7):583588. All the included trials documented postoperative dysphagia, 12 of which have detected it in the early postoperative period. Descriptive statistics were used to summarize demographic and clinicopathologic characteristics. Printza A, Triaridis S (2021) Is the ability of the Eating Assessment Tool (EAT-10) to screen for aspiration in patients with dysphagia depending on the patients disease? These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery. Surg Endosc 32(5):23402344. Careers. World J Surg. Javascript is currently disabled in your browser. This involves cutting the muscle at the lower end of the esophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia. Iran J Otorhinolaryngol 31(107):329334. Google Scholar, Atasayar S, Guler Demir S (2019) Determination of the problems experienced by patients post-thyroidectomy. Here's some information to help you prepare for your appointment. Epub 2018 Sep 7. Results: In the evaluation, 219 questionnaires could be included. Registered in England and Wales. Register your specific details and specific drugs of interest and we will match the information you provide to articles from our extensive database and email PDF copies to you promptly. software development by maffey.com Hyun K, Byon W, Park HJ, Park Y, Park C, Yun JS. All tests of significance were at the P<0.05 level. A prospective randomized controlled trial of the laryngeal mask airway versus the endotracheal intubation in the thyroid surgery: evaluation of postoperative voice, and laryngopharyngeal symptom. Pinchot SN, Youngwirth L, Rajamanickam V, Schaefer S, Sippel R, Chen H. Changes in swallowing-related quality of life after parathyroidectomy for hyperparathyroidism: a prospective cohort study. Scerrino G, Inviati A, di Giovanni S, et al. Bookshelf 2013 Nov;20(12):3869-76 Clipboard, Search History, and several other advanced features are temporarily unavailable. The literature available at PubMed, SciELO and Cochrane Library databases was reviewed, according to PRISMA guidelines, using the terms dysphagia, swallowing disorder, deglutition disorder, thyroidectomy and thyroid surgery in the appropriate combinations. Correlation of dysphagia with patients age, the specimen volume, and patients body mass index was calculated with Spearmans rank correlation coefficient. The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial. Unauthorized use of these marks is strictly prohibited. Dysphagia; Swallowing disorders; Thyroidectomy; Uncomplicated. Careers. 2022 Jan;11(1):270-278. doi: 10.21037/gs-21-708. 2019 Feb;129(2):519-524. doi: 10.1002/lary.27297. Pitt SC, Saucke MC, Wendt EM, Schneider DF, Orne J, Macdonald CL, Connor NP, Sippel RS. Idea for the study: AP, CV. We found that patients in this group are at high risk of dysphagia, since bilateral thyroid surgery is performed in these patients, often with lymph node dissection. The Role of Primary Repair of the Recurrent Laryngeal Nerve during Thyroid/Parathyroid Surgery in Vocal Outcomes-A Systematic Review. -, Codas. National Library of Medicine . Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 ORL J Otorhinolaryngol Relat Spec 82(5):274284. https://doi.org/10.1007/s00268-015-2995-7, Ryu JH, Han SS, Do SH et al (2013) Effect of adjusted cuff pressure of endotracheal tube during thyroidectomy on postoperative airway complications: prospective, randomized, and controlled trial. Testimonials Sixteen patients (7.3%) stated that at a maximum of 3 months after surgery they suffered from dysphagia (answer c). However, only 8% of participants in this study (n = 2) qualified for a follow-up dysphagia evaluation, indicating that the majority of reported symptoms were subjective in nature. Google Scholar, Krekeler BN, Wendt E, Macdonald C et al (2018) Patient-reported dysphagia after thyroidectomy: a qualitative study. In: Ferri's Clinical Advisor 2022. https://doi.org/10.1007/s00405-022-07386-8, DOI: https://doi.org/10.1007/s00405-022-07386-8. Triggs J, et al. Front Surg. Patients were questioned at least 6 months postoperatively. The primary outcomes were compression symptoms, including dysphagia, choking/globus sensation, dyspnea, cough, and hoarseness/dysphonia. The group of patients who did not respond to the questionnaire did not differ significantly from the 219 included patients in terms of age, sex, proportion with cancer, or mass of resected thyroid. J Clin Med. Additionally, some studies have addressed dysphagia after thyroidectomy, but few have discussed assessment and treatment of dysphagia after thyroidectomy. Galluzzi F, Garavello W (2019) Dysphagia following uncomplicated thyroidectomy: a systematic review. or diagnosis X vs non-diagnosis X (X stands for benign struma, hyperparathyroidism, malignancy, and Graves disease) were compared. F1000Research. Results: Unable to load your collection due to an error, Unable to load your delegates due to an error. - 173.82.84.250. An open thyroid biopsy - a rarely used operation where a nodule is excised directly; A hemi-thyroidectomy or thyroid lobectomy - where one lobe (one half) of the thyroid is removed; An isthmusectomy - removal of just the bridge of thyroid tissue between the two lobes; used specifically for small tumors that are located in the isthmus. ani-Hadibegovi A, Hergei F, Babi E, Slipac J, Prstai R. Acta Clin Croat. Management of compression symptoms of thyroid goiters Swallowing dysfunction following surgery for well-differentiated Most patients complaining of long term swallowing disorders had bilateral thyroid resection with or without lymph node dissection. Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, Connor NP. For dysphagia, questions to ask your health care provider include: Your health care provider is likely to ask you a number of questions, including: Until your appointment, it might help to chew your food more slowly and thoroughly than usual. 2014;207(6):974979. Scerrino G, Tudisca C, Bonventre S, Raspanti C, Picone D, Porrello C, Paladino NC, Vernuccio F, Cupido F, Cocorullo G, Lo Re G, Gulotta G. Int J Surg. World J Surg 39(7):17131720. National Institute on Deafness and Other Communication Disorders. Surgery 146(6):11741181. How can I best manage them together? Swallowing dysfunction after thyroid surgery is characterized by . Park YM, Oh KH, Cho JG et al (2018) Changes in voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study. Thyroidectomy (surgical removal of all or part of the thyroid gland) may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. Comparison Between Patient-Perceived Voice Changes and Quantitative Voice Measures in the First Postoperative Year After Thyroidectomy: A Secondary Analysis of a Randomized Clinical Trial. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Here, we investigated the incidence of postoperative dysphagia after uncomplicated thyroidectomy and parathyroidectomy. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimotos thyroiditis. 501-509 Review Article Speech therapy after thyroidectomy reported a qualitative improvement of swallowing function after thyroidectomy . Dysphagia occurred depending on the operative therapy between 6.1% for parathyroid resection and 33% for total thyroidectomy with lymph node dissection. Schmitz-Winnenthal FH, Schimmack S, Lawrence B, et al. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. https://doi.org/10.1111/coa.12913, Rosato L, Avenia N, Bernante P et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. 2017 May 15;29(3):e20150294 https://doi.org/10.1245/s10434-014-4361-7, Lee DY, Lim S, Kang SH et al (2016) A prospective 1-year comparative study of transaxillary total thyroidectomy regarding functional outcomes: is it really promising? Eur Arch Otorhinolaryngol 276(10):26612671. A systematic review. Eur Arch Otorhinolaryngol. A thyroidectomy is the surgical removal of all (total thyroidectomy) or part (partial thyroidectomy) of your thyroid gland the butterfly-shaped organ in your neck. https://doi.org/10.1007/s00268-015-3323-y, Hillenbrand A, Cammerer G, Dankesreiter L et al (2018) Postoperative swallowing disorder after thyroid and parathyroid resection. We'd like to do an assortment of consistencies, so we do a thin liquid, a puree, and then a solid consistency. Diagnostic methods failed to identify the physio pathological mechanism of swallow alteration leaving this condition still unclear. Scerrino G, Inviati A, di Giovanni S, et al. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Some examples are: Laparoscopic Heller myotomy. Please enable it to take advantage of the complete set of features! ani-Hadibegovi A, Hergei F, Babi E, Slipac J, Prstai R. Acta Clin Croat. 2022 Dec 12;9:1064768. doi: 10.3389/fsurg.2022.1064768. However, our study also has several limitations. Disclaimer. Several features of Also, some things you can try to help ease your symptoms include: See your health care provider if you're having problems swallowing. In the also frequently used SF-36 questionnaire, dysphagia is not included.14 All these quality of life studies excluded patients with carcinoma. Antacids that you can get without a prescription also might help temporarily. https://doi.org/10.1089/lap.2015.0546, Bellotti C, Capponi MG, Cinquepalmi M et al (2018) MIVAT: the last 2 years experience, tips and techniques after more than 10 years. https://doi.org/10.1007/s00464-013-3413-6, Jung SP, Kim SH, Bae SY et al (2013) A new subfascial approach in open thyroidectomy: efficacy for postoperative voice, sensory, and swallowing symptoms. 2013 Jun;148(6 Suppl):S1-37. The site is secure. No significant difference was noticed between open and endoscopic thyroid surgery at 2-3 months post-surgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). For example, are certain foods harder to swallow than others? volume279,pages 42134227 (2022)Cite this article. Also at high risk of dysphagia are patients with Graves disease. Thyroid cancer - Diagnosis and treatment - Mayo Clinic What websites do you recommend? World J Surg. Chen X, Wan P, Yu Y, Li M, Xu Y, Huang P, Huang Z. J Voice. Authors Chrysoula Vardaxi 1 2 , Nikolaos Tsetsos 2 , Aikaterini Koliastasi 3 , Alexandros Poutoglidis 2 , Konstantinos Sapalidis 4 , Stefanos Triaridis 1 , Athanasia Printza 5 Affiliations Head Neck 38(6):811819. Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders. Ryu JH, Yom CK, Park DJ, et al. Incidence of Dysphonia and Dysphagia Exceeds Recurrent Laryngeal Nerve Injury During Thyroid Surgery. A two year prospective trial. Improving Voice Outcomes after Thyroid Surgery and Ultrasound-Guided Ablation Procedures. Chapter 8: Assessing risk of bias in included studies. https://doi.org/10.1001/jamaoto.2017.3378, Tomoda C, Sugino K, Tanaka T et al (2018) Globus symptoms in patients undergoing thyroidectomy: relationships with psychogenic factors, thyroid disease, and surgical procedure. World J Surg. 2014;38(2):378384. By accessing the work you hereby accept the Terms. Thorsen RT, Dssing H, Bonnema SJ, Brix TH, Godballe C, Sorensen JR. World J Surg. Scerrino G, Tudisca C, Bonventre S, Raspanti C, Picone D, Porrello C, Paladino NC, Vernuccio F, Cupido F, Cocorullo G, Lo Re G, Gulotta G. Int J Surg. doi: 10.1177/0194599813487301. The most common complications after thyroidectomy are injuries associated with the recurrent laryngeal nerve and parathyroid gland. government site. This study is retrospective, which means no preoperative swallowing disorders were raised and the duration of the postoperative survey was not uniform. One (0.5%) patient stated that up to 3 months postoperatively, swallowing problems had been successfully treated by logopedic therapy (answer d). In 110 (50.2%) patients, the symptoms were only immediately postoperative and later disappeared spontaneously (answer b). Vardaxi, C., Tsetsos, N., Koliastasi, A. et al. The https:// ensures that you are connecting to the Your scar will be most visible for the first 1-2 months after surgery, improve Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months). Table 1 Questionnaire sent to 358 patients at least 6 months postoperatively. 2015;39(7):17131720. MeSH In 110 (50.2%) patients, dysphagia was reported only immediately postoperative and disappeared later spontaneously. Vagal nerve and inferior laryngeal nerve were identified systematically with intermittent nerve monitoring. Radioactive Iodine Therapy for Thyroid Cancer: Outpatient Treatment The common post-thyroidectomy neurological complications noted were hoarseness of voice (6 patients), loss of voice pitch (7), breathy voice (8), respiratory stridor (2), and dysphagia to liquids (8). Approximately 15% of subjects 65 years and older reported difficulties with swallowing.20 These patients were not excluded. eCollection 2023 Jan. Front Surg. ESTIMation of the ABiLity of prophylactic central compartment neck Surgery might be needed to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticula, GERD and achalasia, or to treat esophageal cancer. In the group of smokers, 5 out of 24 (20.8%) patients reported dysphagia and 34 out of 194 (17.5%) non-smokers patients reported dysphagia (no significant difference; chi-squared test=0.2). Another aim was to review the literature on speech therapy for patients with recurrent laryngeal nerve paralysis after thyroidectomy. Clin Otolaryngol 41(5):615618. 2018 Nov 1;144(11):995-1003. doi: 10.1001/jamaoto.2018.0309. JAMA Otolaryngol Head Neck Surg. Accessed 1 Nov 2020, Alkan Z, Yigit O, Adatepe T et al (2014) Effect of anti-adhesive barrier use on laryngotracheal movement after total thyroidectomy: an electrophysiological study. Article Google Scholar Grover G, Sadler GP, Mihai R . Surgery 133(3):318322. https://doi.org/10.1245/s10434-013-3163-7, Sinclair CF, Bumpous JM, Haugen BR et al (2016) Laryngeal examination in thyroid and parathyroid surgery: an American Head and Neck Society consensus statement. https://doi.org/10.1007/s00464-002-8830-x, Article 2009;24(1):16. Front Oncol 9:1226. https://doi.org/10.3389/fonc.2019.01226, Zhang Z (2014) Efficacy comparison of the anterior low small incision and the traditional incision for treatment of thyroid adenoma. ANZ J Surg 73(9):712716. In literature, we found no comparable study regarding Graves disease, although Cramon et al report that Graves disease causes severe disease-specific and generic health-related quality of life impairments, and deficits persist after treatment.15 One particular aspect of Graves disease could be inflammation, which can favor postoperative scarring.
Categories
