973 The Journal of Laryngology & Otology December 2005, Vol. 119, pp. 973–975 Thyroidectomy does not cause globus pattern symptoms K H MAUNG, FRCS, D HAYWORTH, RGN, P A NIX, FRCS, S L ATKIN,PHD, MRCP*, R J A ENGLAND, FRCS (ORL-HNS) Abstract Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow–Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them. Key words: Thyroidectomy; Deglutition Disorders; Pharynx; Questionnaires Introduction Globus pharyngeus is a diagnosis of exclusion, as its cause has not been definitively identified thus far. Globus, derived from the Latin word for a ball, is classically taken to mean ‘a feeling of a lump in the throat’. This psychosomatic syndrome most frequently occurs in middle-aged women in the absence of other symptoms suggestive of an upper aerodigestive tract tumour. In 1707 John Purcell coined the term globus hystericus, and it was a recognized presenting symptom of hysteria in the eighteenth century. 1 It is a syndrome common enough to account for 4 per cent of all referrals to general ENT departments in the UK. 2 When this group of symptoms presents it is vital to exclude any sinister pathology prior to making the diagnosis. One of the organic pathologies recognized as causing globus pattern symptoms is a goitre. 3 Indeed in some units thyroidectomy is advocated for globus in the presence of goitre. 4 However, in the absence of retrosternal extension it is hard to understand how an enlarged thyroid gland can cause significant pharyngoesophageal compression, if indeed this is the organic cause of the symptom. In addition, post- thyroidectomy patients often complain of globus pattern symptoms, although these symptoms frequently settle with time. Recognizing the globus symptom as a psychosomatic disorder that presents in clinics dealing with organic pathologies, Deary et al. developed the Glasgow–Edinburgh Throat Scale. 5 This is a questionnaire containing 10 questions directly relating to individual throat symptoms and two further questions aimed at quantifying the degree of somatic distress, or overall anxiety, these symptoms cause (Table I). The respondent gives a score for each question ranging from 0 to 7, where 0 equates to being totally unaffected by the symptom and 7 equates to being unbearably affected by it. The purpose of this instrument is to characterize the nature and severity of the globus sensation and enable observers to assess response of the symptom to differing treatment modalities. The aim of this study was to examine the relationship of globus to goitre and thyroidectomy. By using thyroidectomy patients as their own controls, we have employed the Glasgow–Edinburgh Throat Scale to see whether the operation worsens globus symptoms. Materials and methods After obtaining ethical approval from the Hull and East Yorkshire Research and Ethics Committee, 41 verbally-consented patients were prospectively recruited prior to undergoing thyroidectomy (see Table II for pathologies and thyroid function at From the Departments of Otolaryngology–Head and Neck Surgery and *Endocrinology, Hull Royal Infirmary, Hull, UK. Accepted for publication: 13 June 2006.