Horner's syndrome in association with thyroid and parathyroid disease

Background: Injury to the cervical sympathetic chain and its consequence, Horner's syndrome, as a result of thyroid pathology or surgical intervention is an uncommon complication. The purpose of the present study was to examine the experience of one endocrine surgical unit with pre and postoperative Horner's syndrome. Methods: This is a retrospective case series. The study group comprised all patients undergoing thyroid and parathyroid surgery at Royal North Shore Hospital from January 2000 to October 2003 who were identified as having either pre or postoperative Horner's syndrome. Patient demographics, operation performed, underlying pathology and outcomes were evaluated. Results: There were nine cases of Horner's syndrome recorded from a total of 2208 thyroid and parathyroid operations undertaken: three with preoperative Horner's, an incidence of 0.14%, six with postoperative Horner's, an incidence of 0.27%. Patients ranged in age from 22 to 87 years. Two of the three preoperative cases were related to benign pathology, the remaining case having anaplastic carcinoma. Five of the six postoperative cases were related to thyroid malignancy with lymph node dissection; one case was associated with benign parathyroid pathology. Conclusions: Cervical sympathetic chain injury is a rare complication of surgery for thyroid and parathyroid conditions. The presence of preoperative Horner's does not necessarily indicate an underlying malignancy.