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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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The human larynx, often referred to as the voice box, is an intricate organ located in the neck. It serves as a pathway for air to enter the lungs during respiration and is an essential component of voice production.
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Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...

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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Published on: October 24, 2025

Recurrent laryngeal nerve diameter increases during thyroidectomy.

Jonathan W Serpell1, Stacey Woodruff, Michael Bailey

  • 1Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, VIC, Australia. serpellj@bigpond.com

Annals of Surgical Oncology
|March 4, 2011
PubMed
Summary
This summary is machine-generated.

Thyroidectomy can cause voice changes due to recurrent laryngeal nerve (RLN) swelling, not just palsy. This study measured RLN diameter during surgery, finding it increased, potentially explaining post-operative voice alterations.

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Area of Science:

  • Otorhinolaryngology
  • Surgical Neurology
  • Thyroid Surgery

Background:

  • Temporary recurrent laryngeal nerve (RLN) palsy post-thyroidectomy is typically neurapraxia.
  • Voice changes are common after thyroidectomy, even without RLN palsy.
  • Edema-induced RLN diameter increase is hypothesized to cause these voice changes.

Purpose of the Study:

  • To document changes in the diameter of the recurrent laryngeal nerve (RLN) during thyroidectomy.
  • To investigate the relationship between RLN diameter changes and electromyogram (EMG) amplitudes.
  • To explore factors influencing RLN diameter and EMG amplitude variations.

Main Methods:

  • Prospective analysis of 110 recurrent laryngeal nerves (RLNs) in 75 patients undergoing thyroidectomy.
  • Measurement of RLN diameter upon identification and lobe removal.
  • Concurrent recording of electromyogram (EMG) amplitudes via neurostimulation, followed by univariate and multivariate analyses.

Main Results:

  • Mean RLN diameter increased by 0.71 mm (from 1.95 mm, P < 0.001).
  • Increasing age and greater EMG amplitude difference predicted increased RLN diameter.
  • A positive relationship was observed between increased RLN diameter and increased EMG amplitude (R(2) = 0.04).

Conclusions:

  • Increased RLN diameter, likely due to edema, may explain voice changes post-thyroidectomy without palsy.
  • The cause of RLN edema during surgery remains unknown.
  • Increased EMG amplitude associated with larger RLN diameter may indicate heightened neuronal ionic channel excitability.