Answer to The Once and Future Beefeater

Correct answer is E.

Goiters are not uncommon, and individuals who lack sufficient iodine in their diet are prone tot hem. The thyroid gland responds to low iodine by secreting more hormone to stimulate the growth of the thyroid. The mention of central Africa is a clue - inland areas are often diminished in iodine and the incidence of goiter is increased. Goiters are treatable and may not necessarily require surgery. However, in this case, the sudden need to fit into the Beefeater custom led the actor to undergo the surgery, and he was fortunate, the thyroid cancer was detected and removed. Unfortunately, based on the description of the deficits that ensued, the external laryngeal nerve was damaged. This nerve innervates the cycothyroid muscle that promotes lengthening and thinning of the vocal folds, increasing voice pitch. Damage to the nerve can cause hoarseness, difficulty in swallowing or breathing, or the loss of voice. Fortunately, the actor only experienced weakness in his voice after the surgery.

Answer to this question is based on material presented in lectures 6 of the Head and Neck Lecture Series.

1 = Superior root ansa cervicalis

2 = Inferior root ansa cervicalis

3 = Hypoglossal n.

4 = Internal laryngeal n.

5 = External laryngeal n.