Supporting each other with wings, starting a new journey - rehabilitation training after thyroid cancer surgery

Thyroid cancer is known as a "not-so-cold killer" because of its common pathological classification of papillary carcinoma, which accounts for about 90% of thyroid cancer and has a good prognosis. In the past 10 years, thyroid cancer has been the No. 1 in the compensation rate of serious cancer insurance. "Thyroid cancer" has successfully transformed from an unknown little role to a rising "new star" in the cancer family.

For most pathological types of thyroid cancer, surgery is the preferred treatment option, and then it is combined with chemotherapy, radiotherapy, endocrine therapy, targeted therapy, etc. according to different pathological types.

Hoarseness and scar hyperplasia and compression at the surgical site are common symptoms after thyroid cancer surgery. Transient hoarseness will spontaneously resolve within 24-48 hours, usually due to vocal cord edema caused by endotracheal intubation. Symptomatic voice changes generally improve quickly after surgery. If hoarseness, uncontrollable coughing during speech, dyspnea for more than 24-48 hours, or aspiration pneumonia occur, abnormal vocal cord movement should be suspected. Such patients should undergo direct laryngoscopy and comprehensive laryngeal nerve evaluation immediately. Thyroid cancer surgery may damage three nerves: the external branch of the superior laryngeal nerve, the recurrent laryngeal nerve, and the vagus nerve. Damage to the external branch of the superior laryngeal nerve can cause vocal weakness or vocal fatigue, as well as changes in sound quality and tone; damage to the recurrent laryngeal nerve can cause paresis or paralysis of the true vocal cord on the ipsilateral side in the paramedian or lateral position; damage to the vagus nerve can paralyze both the superior laryngeal nerve and the recurrent laryngeal nerve.

For symptoms of vocal cord paralysis such as hoarseness and weak voice, we can try to use voice training and neck functional training to help patients improve their voice, relieve stress and reduce anxiety.

The training is conducted in a one-on-one or 2-3-person group face-to-face format. If the patient's condition changes (such as upper respiratory tract infection, etc.), voice training will be suspended and training will resume after recovery.

Warm-up exercise:

①Abdominal breathing training:

Sit upright, keep your neck, shoulders and jaw relaxed, look forward, and when you inhale, make the abdomen below the xiphoid process bulge as much as possible, and when you exhale, let the abdomen sink inward. Repeat 20 times.

② Lip tremor:

Take a deep breath, purse your lips slightly, and exhale naturally, making your lips vibrate and make a "puff puff puff" sound. Repeat this 20 times.

Pronunciation training:

① Throat swing exercise:

The patient should relax his shoulders and neck, use the thumb and the other four fingers of one hand to hold the thyroid cartilage steadily, and swing it to the left and right with a small amplitude and high frequency, while making an "ah-ah" sound, relax the laryngeal muscles, stop swinging and pronunciation at the same time, inhale through the nose, contract the abdomen, and count from 1 to 10. The pronunciation should be short and powerful.

② Uh-huh:

The patient breathes naturally, makes the nasal sound "hmm", inhales through the nose, contracts the abdomen and counts from 1 to 10. The pronunciation points are the same as before.

③Blow bubbles:

The patient puts one end of the straw into the water cup, inhales through the nose, holds the other end of the straw in his mouth and continuously blows out gas, relaxes the vocal cords, inhales through the nose, tightens the abdomen and counts from 1 to 10. The pronunciation points are the same as before.

④Resonance training:

The patient pronounces /ma-----/ with a slow rhythm using the base tone, breathes naturally, and then pronounces /ma----/ with a faster rhythm. The two sets are performed alternately, one slow and one fast. Pay attention to the rhythm and feel the vibration on both sides of the nose and in the front of the mouth.

⑤Gliding movement:

The patient inhales deeply through the nose to pronounce /wu/, pauses and holds his breath for 3 seconds when pronouncing from the low tone to the highest tone, opens his mouth and exhales slowly to relax.

⑥ Vocal cord functional exercise:

Choose the vowel /a/, and gradually slide from the lowest pitch to the highest pitch, and then from the highest pitch to the lowest pitch, and repeat this process 10 times.

Tongue movement training:

①Tongue flexibility training:

Following the therapist's instructions, the patient touched the upper lip, lower lip, left corner of the mouth, right corner of the mouth, back of the upper dentition, back of the lower dentition, left buccal mucosa, and right buccal mucosa with the tip of the tongue.

②Tongue muscle strength training:

The patient sticks out his tongue forcefully to resist the therapist's force of using a tongue depressor to block the tongue from sticking out; each time lasts for 5 seconds, and 10 times constitute a set.

Sternocleidomastoid and trapezius muscle strength training:

① Sternocleidomastoid muscle strength training:

The patient turns his head to the healthy side with force against the resistance applied by the therapist's hands, each time lasting 10 seconds, 10 times as a set.

②Trapezius muscle strength training:

The patient places a 2kg sandbag on the affected shoulder as resistance and performs shoulder shrug exercises, each lasting 10 seconds, 10 times as a set.

Neck and shoulder exercise rehabilitation training **: Thyroid cancer patients should undergo neck and shoulder training early after surgery to prevent joint stiffness and reduce scar contracture**. Rehabilitation training should be started 3 days after surgery. The specific movements are as follows:

① Neck movement:

First, the patient's mandibular angle is close to the center of the sternum, 45° to the left front, 90° to the left, 45° to the right, and 90° to the right, and the head is lowered for 2 to 3 minutes; then the mandible is rotated 180° close to the left and right shoulders, alternating back and forth for 1 to 2 minutes.

②Shoulder movements:

First, do shoulder shrug exercise, alternating left and right, for 1 to 2 minutes. Then rotate the shoulder joint 360 degrees left and right for 1 minute. Finally, make fists with both hands and bend the elbows 90 degrees, and do chest expansion exercise for 1 to 2 minutes. Instruct the patient to continue training 1 to 2 times a day after discharge.

Health education: drink more water, quit smoking and drinking, avoid spicy and greasy food, reduce the intake of caffeinated foods (such as strong tea, coffee), avoid voice abuse (such as shouting), and reduce negative vocal cord behaviors.