Post-operative Horner's Syndrome Following Total Thyroidectomy: A Case Report

Abstract

The oculosympathetic chain is a three-neuron pathway responsible for sympathetic innervation to the eye, which follows a complex anatomical course through the head and neck. Neck surgery may cause injury to this pathway, causing loss of sympathetic innervation producing the eponymous Horner's syndrome (ipsilateral ptosis, miosis and anhidrosis), but this is rare in the reported literature. We present the case of a 23-year-old female who underwent total thyroidectomy for a right-sided, metastatic papillary thyroid carcinoma. Following surgery, in the immediate postoperative period, she was noted to have unilateral ptosis and miosis. This patient was assessed by an ophthalmologist due to persistent unilateral ocular symptoms following thyroidectomy. She was subsequently diagnosed with right-sided Horner's syndrome. The diagnosis was confirmed following the observed reversal of her ocular symptoms using apraclonidine 1% minims. The management of Horner's syndrome following thyroidectomy is conservative if no evidence of compressive hematoma or seroma is identified as in this case. The patient was followed up at six weeks following thyroidectomy and a partial improvement in ptosis was noted. The patient also reported blurred vision secondary to increased refractive error due to reduced pupillary function in her right eye. Prognosticating recovery from Horner's syndrome following thyroidectomy is challenging due to limited evidence. Horner's syndrome as a possible complication of thyroidectomy should be counselled to patients pre-operatively. A residual deficit from Horner's syndrome may cause functional impairment in addition to the poor cosmetic outcome.