Lost for Words – Bilateral Vocal Cord Paresis following Renal Dialysis of a Thyroidectomy Patient

A patient underwent a total thyroidectomy for a small papillary thyroid cancer. Her vocal cord function was assessed as being normal post-operatively. A week later she underwent her first veno-venous renal dialysis for deteriorating renal function during the post-operative period. Within 48 hours she had developed bilateral vocal cord paresis, presumed to be on the basis of bilateral recurrent laryngeal nerve oedema precipitated by massive fluid shifts in the fresh surgical bed. Her voice recovered over the subsequent days as her fluid balance normalized.