Vagus Nerve Stimulation After Thyroidectomy and RAI: Safety for Relaxation
Vagus nerve stimulation (VNS) is safe to use for relaxation and calming purposes in patients who have undergone total thyroidectomy and radioactive iodine (RAI) therapy. According to clinical guidelines, repetitive stimulation of the vagus nerve has been demonstrated to be safe and is not associated with neural injury, cardiac arrhythmias, or bronchospasm in adults 1.
Safety Evidence for Vagus Nerve Stimulation
The International Neural Monitoring Study Group, based on their cumulative experience and literature review, has stated that repetitive stimulation of the vagus nerve is not associated with neural injury and has been safely applied in both children and adults 1.
Vagal stimulation during monitoring is not associated with cardiac arrhythmias or bronchospasm, making it safe for post-thyroidectomy patients 1.
Many authors have demonstrated the safety of repetitive recurrent laryngeal nerve (RLN) and vagus nerve stimulation during thyroidectomy procedures 1.
Considerations for Post-Thyroidectomy Patients
After total thyroidectomy and RAI, the primary concerns are related to the absence of thyroid tissue and potential changes in neck anatomy, but these do not contraindicate external vagus nerve stimulation for relaxation purposes 1.
Post-thyroidectomy patients are typically monitored with serum thyroglobulin (Tg) levels and neck ultrasound, but these follow-up protocols do not restrict the use of vagus nerve stimulation for relaxation 1.
For patients who have undergone RAI therapy, there are no specific contraindications to using non-invasive vagus nerve stimulation devices for relaxation 1.
Important Distinctions and Caveats
It's important to distinguish between invasive continuous vagal nerve monitoring (CVNM) used during surgery and non-invasive transcutaneous VNS used for relaxation:
If using a device for vagus nerve stimulation, ensure it is designed for transcutaneous (external) use rather than invasive stimulation 4, 5.
Start with lower intensity settings when beginning vagus nerve stimulation for relaxation, especially in the post-surgical period, to monitor for any individual sensitivity 3.
If you experience any unusual symptoms such as voice changes, heart rhythm irregularities, or discomfort during stimulation, discontinue use and consult your healthcare provider 1.
Conclusion for Clinical Practice
Transcutaneous vagus nerve stimulation can be safely used for relaxation and calming purposes in patients who have undergone total thyroidectomy and RAI therapy 1.
The benefits of relaxation and stress reduction may be particularly valuable for thyroid cancer survivors managing the psychological aspects of their diagnosis and treatment 1.
Regular follow-up with your endocrinologist should continue as recommended based on your risk stratification, regardless of VNS use for relaxation 1.