Swallowing Dysfunction Following Uncomplicated Thyroid and Parathyroid Surgery: A Prospective Evaluation of Early and Late Postoperative Changes.

Dysphagia is a complication that may occur after thyroidectomy or other head and neck surgeries. This complaint is usually associated with inferior and superior laryngeal nerve dysfunction, but it can also occur without nerve damage. The aim of this study is to evaluate the frequency, severity, and clinical course of dysphagia developing in the early and late periods after thyroid and parathyroid surgeries, to determine its effects on patients' postoperative quality of life, and to contribute to optimal management strategies. Between January 2016 and September 2017, a total of 76 patients were prospectively evaluated: 25 who underwent parathyroidectomy (Group 1), 26 who underwent total thyroidectomy with central neck dissection (Group 2), and 25 who underwent total thyroidectomy without central neck dissection (Group 3). Swallowing function and postoperative quality of life were assessed using fiberoptic endoscopic evaluation of swallowing (FEES), the Swallowing Quality of Life questionnaire (Swal-QoL), and the Eating Assessment Tool (EAT-10), applied preoperatively, at postoperative week 1 (early postoperative period, EPO), and at week 8 (late postoperative period, LPO). Early postoperative swallowing changes were observed in 16% of parathyroidectomy patients, 20% of thyroidectomy patients without central neck dissection, and 36% of those with central dissection. Significant between-group differences were found for FEES liquid swallows (p = 0.006), EAT-10 (p = 0.003, p = 0.001), and Swal-QoL scores (p = 0.011, p = 0.001). Longitudinal analysis showed significant changes in EAT-10 and Swal-QoL across all periods (p < 0.001). While parathyroidectomy patients showed only minimal transient changes, thyroidectomy with central dissection caused early FEES impairments and persistent subjective complaints, and thyroidectomy without dissection mainly affected patient-reported outcomes despite normal FEES findings. This study demonstrates that dysphagia is common after thyroid and parathyroid surgery and that its course is closely related to the extent of surgery. While swallowing function is largely preserved after parathyroidectomy, thyroidectomy without central neck dissection may lead to significant reductions in quality of life. In patients undergoing thyroidectomy with central neck dissection, early objective impairments and persistent late subjective complaints were observed. As the extent of surgery increases, the risk of dysphagia also rises, and subjective symptoms may persist even after objective findings return to normal. Therefore, routine postoperative swallowing assessment, comprehensive preoperative counseling, and, when necessary, early rehabilitation programs are critical to preserving long-term quality of life.