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Staged Thyroidectomy: A Single Institution Perspective.

Che-Wei Wu1,2, Hui Sun3, Guang Zhang3

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Intraoperative neuromonitoring (IONM) loss of signal (LOS) during thyroid surgery necessitates strategic decisions. Staged thyroidectomy is often preferred to avoid bilateral vocal cord palsy, especially in low-risk cases.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Neuroscience

Background:

  • Intraoperative neuromonitoring (IONM) is increasingly used in thyroid surgery.
  • Loss of signal (LOS) during IONM on the first side of a planned total thyroidectomy requires specific management strategies.

Purpose of the Study:

  • To review author experience with IONM in total thyroidectomy following LOS on the first side.
  • To determine the incidence of LOS and compare intraoperative management strategies.

Main Methods:

  • Intermittent IONM using vagal and recurrent laryngeal nerve stimulation (V1, R1, R2, V2).
  • Pre- and postoperative laryngoscopy.
  • Informed patient consent for potential staged thyroidectomy.

Main Results:

  • LOS occurred in 2.8% of 803 thyroid procedures.
  • Staged thyroidectomy was performed in 20 cases; total thyroidectomy in 3 high-risk cases.
  • No bilateral recurrent laryngeal nerve (RLN) palsy occurred; 21 cases had postoperative RLN palsy.

Conclusions:

  • IONM influences surgical decision-making, advocating for multidisciplinary and patient-centered approaches.
  • Options for contralateral surgery after ipsilateral LOS include staged thyroidectomy, subtotal resection, or completion total thyroidectomy based on pathology and patient factors.
  • Staged thyroidectomy is recommended for bilateral goiter, Graves' disease, or low-risk thyroid carcinoma to prevent bilateral vocal cord palsy.