A few patients have experienced a series of “strange” symptoms after thyroid cancer surgery: drooping eyelids on one side, smaller eyes, and no facial sweating.
This set of abnormalities, medically known as Horner syndrome, is a sign of sympathetic nerve damage in the neck. Why would thyroid cancer surgery injure this group of nerves? Let’s look at the connection between them.
The carotid sheath (CS) is like a “ring” that surrounds the important blood vessels and nerves in the neck. The cervical sympathetic nerve is adjacent to it. During thyroid cancer surgery, the carotid sheath may be pulled back to compress the cervical sympathetic nerve, causing local hematoma or ischemic injury to the nerve.
In addition, the cervical sympathetic trunk consists of three ganglia: superior, middle, and inferior, and the middle cervical ganglion is adjacent to the inferior thyroid artery. It has also been reported that the cervical sympathetic nerve is supplied by a branch of the inferior thyroid artery. Therefore, surgical removal of the thyroid gland, and ligation of the inferior thyroid artery, may damage this nerve.
Sympathetic nerve injury from intraoperative hematoma or inflammatory irritation usually resolves. However, symptoms persist after surgery in about 70% of patients.
Co-written by Dr. Jiaqian Hu, Cancer Hospital of Fudan University