Short summary

Most patients undergoing thyroidectomy experiences reduced voice function, pain and in general reduced quality of life in the first weeks or months after surgery.

This intervention study will examine the effect of stretching exercises as rehabilitation in patients undergoing thyroidectomy due to benign thyroidea diseases. The outcome of the proejct is short-time quality of life focusing on voice function and pain. The hypothesis is, that the patients will benefit from the stretching exercises and therefore have better shorttime quality of life. 

Rationale

Background/Introduction

Removing all or part of the thyroid gland by surgery, has routinely been used for more than 100 years for the treatment of patients with benign as well as malignant thyroid disease. It is generally accepted that quality of life is improved three-to-six months after surgery (Mishra, Sabaretnam et al. 2013)  (Sorensen, Watt et al. 2017) (Watt, Cramon et al. 2014). However, in the days and weeks following thyroid surgery, patients often experience muscle pain and stiffness of the neck and shoulders (Yuuki Takumara 2005). In addition, 2-4 weeks postoperatively voice discomfort symptoms can be pronounced, and although short-termed and passing, patients experience a decreased quality of life (Sorensen, Printz et al. 2019) (Vicente, Solomon et al. 2014) (Ryu, Ryu et al. 2013). The accumulation of such symptoms in the weeks just after surgery may reduce quality of live significantly. Therefore, any rehabilitative interventions which may reduce discomfort are highly relevant. 

A limited number of randomized trials have investigated the effect of early postoperative rehabilitative measures such as neck stretching. Rehabilitation with stretching exercises is found to reduce neck pain, neck stiffness, and the need for postoperative pain relief medication (Yuuki Takumara 2005) (Hatice Ayhan 2016). No study has examined the effect of neck stretching exercises on short term quality of life improvements in relation to voice function despite many of the neck muscles are used for voice production. The same goes for the impact of neck stretching exercises on short term quality of life improvements in relation to neck pain. 

Objective/Purpose

The objective is to examine the effect of neck stretching exercises performed shortly after hemi- and total thyroidectomy on short term quality of life in relation to subjective voice function and neck pain in the first four weeks after surgery. 

Description of the cohort

In-hospital patients with benign thyroid disease having undergone thyroid surgery at the

Department of ORL - Head and Neck Surgery, Odense University Hospital.

Patients will be recruited for this randomized controlled clinical study the day after surgery.

The patients are randomized to either intervention with eight specific and carefully selected

neck stretching exercises or to the control group without any intervention.

Inclusion criteria

• Patients undergoing either hemi- or total thyroidectomy for a benign thyroid disease

Exclusion criteria

• Pre-operative recurrent laryngeal nerve palsy 

• Pre-operative voice disorder requiring treatment by surgery or speech language pathology

• Previous neck surgery including thyroid surgery

Data and biological material

Questionnaires

Collaborating researchers and departments

Department of ORL – Head and Neck Surgery, Odense University Hospital, Region of Southern Denmark:

• Professor, Chief Physician, PhD., Christian Godballe 
• Chief Physician, PhD. Helle Døssing

Department of Endocrinology, Odense University Hospital, Region of Southern Denmark:

• Professor, dr. med. Steen Joop Bonnema
• Chief Physician, PhD., Thomas Brix