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<p>Hoarseness is a frequent symptom of thyroid disorders, usually attributed to recurrent laryngeal nerve injury from thyroid enlargement or surgery. However, vocal fold atrophy secondary to thyroid hormone imbalance is extremely rare. A 30-year-old woman with poorly controlled hyperthyroidism presented with progressive hoarseness. Laryngoscopy revealed bilateral bowing of the vocal folds with a small phonation gap, while thyroid function tests confirmed marked thyrotoxicosis. No evidence of neural compression was observed. Excess thyroid hormone induces a hypermetabolic, catabolic state that accelerates protein degradation and muscle wasting, potentially involving the intrinsic laryngeal muscles such as the thyroarytenoid. This leads to thinning of the vocal folds and glottic insufficiency, producing hoarseness even in the absence of neural injury. Recognition of this rare mechanism is essential to avoid misdiagnosis as neurogenic paresis and to guide appropriate management aimed at restoring euthyroid status and improving vocal function.</p>

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Vocal Fold Atrophy as an Uncommon Cause of Hoarseness in Hyperthyroidism: A Case Report

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Nurul Nabilla Sabri,
  • Muhammad Nu’aim Ishak,
  • Nur Najihah Mohd Yusof,
  • Nor Kamaruzaman Esa,
  • Salman Amiruddin,
  • Mohd Sayuti Razali

摘要

Hoarseness is a frequent symptom of thyroid disorders, usually attributed to recurrent laryngeal nerve injury from thyroid enlargement or surgery. However, vocal fold atrophy secondary to thyroid hormone imbalance is extremely rare. A 30-year-old woman with poorly controlled hyperthyroidism presented with progressive hoarseness. Laryngoscopy revealed bilateral bowing of the vocal folds with a small phonation gap, while thyroid function tests confirmed marked thyrotoxicosis. No evidence of neural compression was observed. Excess thyroid hormone induces a hypermetabolic, catabolic state that accelerates protein degradation and muscle wasting, potentially involving the intrinsic laryngeal muscles such as the thyroarytenoid. This leads to thinning of the vocal folds and glottic insufficiency, producing hoarseness even in the absence of neural injury. Recognition of this rare mechanism is essential to avoid misdiagnosis as neurogenic paresis and to guide appropriate management aimed at restoring euthyroid status and improving vocal function.