laryngeal nerve stops firing: MG connection?
 

Hi, everyone. I have had MG for seven years. I have a relatively mild case.

I recently had two surgeries for follicular thyroid cancer. The first surgery was supposed to be a total thyroidectomy, but had to be halted halfway through when my left laryngeal nerve stopped firing. It took six weeks for it to wake up. Then I had more surgery to remove the right side of my thyroid, and the same thing happened--the right nerve stopped firing.

The surgeon is sure he didn't damage either nerve. He says he's never had this happen twice on the same patient. He is wondering whether there's some MG connection.

I don't see how there could be. MG attacks muscle cells, right? This is definitely a nerve problem. The surgeon was using a nerve monitor (which is a good thing--two frozen vocal cords at the same time, and you can't breathe). That's how he knew the nerve stopped firing each time.

Any ideas?

Myasthenia is about communication failure at the nerve-muscle junction. It's not the muscle itself, or the nerve itself. There are several tests you can do e.g. antibody blood tests, EMG test, tensilon test, seeing if pyridostigmine helps.

If I were in your position, I'd want to know more about how exactly the nerve monitor works - is it tracking the actual nerve or is it tracking the transmission of messages from the nerve to the muscle?

Good luck.

Geez, Abby, that's really frightening. It's good that your doctor was so aware.

Well, the muscle receptors are damaged in MG. What if the drugs they gave you during surgery (what were they?) were the cause? That makes more sense to me. It may have made MG worse.

That's about all I can think of.

Annie