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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

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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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Related Experiment Video

Updated: Apr 30, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Assessment of recurrent laryngeal nerve function during thyroid surgery.

J Smith1, J Douglas, B Smith

  • 1Worcestershire Acute Hospital NHS Trust, UK.

Annals of the Royal College of Surgeons of England
|May 1, 2014
PubMed
Summary

Thyroid surgery can cause temporary or permanent recurrent laryngeal nerve (RLN) palsy. Direct laryngoscopy reliably assesses vocal cord function, unlike intraoperative nerve monitoring, and most temporary palsies resolve within four months.

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Area of Science:

  • Otolaryngology
  • Endocrinology
  • Surgical Oncology

Background:

  • Discrepancies exist in reported rates of recurrent laryngeal nerve (RLN) palsy after thyroidectomy, often due to varied vocal cord function assessment methods.
  • Understanding the incidence and natural history of temporary and permanent vocal cord palsy is crucial for patient management post-thyroid surgery.

Purpose of the Study:

  • To determine the incidence and natural course of temporary and permanent vocal cord palsy following thyroidectomy.
  • To evaluate the utility of intraoperative nerve monitoring in predicting vocal cord palsy outcomes.

Main Methods:

  • Prospective data collection from consecutive thyroidectomy patients.
  • Utilized intraoperative nerve monitoring with an endotracheal tube device in all cases.
  • Assessed laryngeal function via endoscopic examination on postoperative day 1 and at 3 weeks.

Main Results:

  • Analyzed data from 102 patients (123 nerves); reported temporary RLN palsy rate of 6.1% and permanent rate of 1.7%.
  • Most palsies were detected on postoperative day 1, with all identified by 3 weeks; no preoperative risk factors were found.
  • Intraoperative nerve monitoring did not predict vocal cord function outcomes; dysphonia at 3 weeks was a predictor, but not all palsies caused dysphonia.

Conclusions:

  • Direct laryngoscopy is the definitive method for assessing vocal cord function post-thyroidectomy.
  • Intraoperative nerve monitoring is unreliable for predicting vocal cord function or long-term laryngeal function.
  • The observed 4-month recovery for all temporary palsies has implications for planning subsequent surgical procedures.