Post-Thyroidectomy Stridor — FRCA Final MCQ
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Correct answer: C — Bilateral recurrent laryngeal nerve injury
Bilateral recurrent laryngeal nerve injury is the best answer. The recurrent laryngeal nerves supply all intrinsic laryngeal muscles except the cricothyroids. Bilateral injury prevents vocal-fold abduction, leaving the folds near the midline and producing a critically narrowed glottic aperture, inspiratory stridor and respiratory distress. Urgent airway support and early ENT involvement are required. Unilateral injury commonly causes hoarseness but usually preserves an adequate airway. A wound haematoma causes extrinsic airway compression and is usually associated with neck swelling or tension, although this may occasionally be subtle. Tracheomalacia is associated particularly with longstanding large goitres and would not cause bilateral vocal-fold immobility. Laryngospasm causes active glottic closure, usually during emergence, rather than persistent failure of abduction in a fully awake patient.
Reference: University Hospitals Dorset NHS Foundation Trust. Thyroidectomy, section: Voice change and damage to recurrent laryngeal nerves. Current patient information PDF, accessed 8 August 2026. https://www.uhd.nhs.uk/uploads/about/docs/our_publications/patient_information_leaflets/surgery/thyroidectomy.pdf