Iatrogenic Horner Syndrome after a mini-invasive thyroidectomy procedure: case report and medico-legal implications of a rare complication in neck surgery

We report the case of a 36-year-old man with papillary thyroid carcinoma that infiltrated the trachea, who suffered damage to the sympathetic innervation during total thyroidectomy. The case was referred for medico-legal evaluation owing to the onset of iatrogenic Horner Syndrome. Although the informed consent form signed by the patient provided an exhaustive list of the main complications of thyroidectomy, it did not report the risk of damage to the sympathetic pathway. Moreover, immediately after being roused from anaesthesia, the patient complained of symptoms attributable to the syndrome; these were underestimated by physicians and the pathology went unrecognised. However, the symptoms caused by the definitive lesion of the sympathetic pathway persisted, and the diagnosis was made two months after surgery. Horner Syndrome is a rare complication in thyroid surgery. Nevertheless, given the close and variable anatomical relationships with the thyroid, care must always be taken to preserve the sympathetic nerve pathways, and patients should be informed of the risk of possible damage. Finally, any signs and symptoms of damage warrant prompt neuro-ophthalmological investigation.