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Updated: Sep 27, 2025

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Selective laryngoscopy before thyroidectomy: a risk assessment.

Katherine A Black1, David S Wilkinson1

  • 1Breast and Endocrine Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

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|April 11, 2022
PubMed
Summary
This summary is machine-generated.

Routine preoperative laryngoscopy before thyroidectomy is not essential for all patients. The risk of bilateral vocal cord palsy (VCP) is statistically low, even without routine screening, especially for patients without pre-existing risk factors.

Keywords:
laryngoscopyrecurrent laryngeal nerve injuryrisk assessmentthyroidectomyvocal cord paralysis

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Area of Science:

  • Otolaryngology
  • Endocrine Surgery

Background:

  • Unrecognized pre-existing vocal cord palsy (VCP) poses a risk during thyroidectomy.
  • Injury to the recurrent laryngeal nerve (RLN) on the single functioning side can lead to bilateral VCP.

Purpose of the Study:

  • To quantify the risk of bilateral vocal cord palsy (VCP) in patients undergoing thyroidectomy.
  • To evaluate the necessity of routine preoperative laryngoscopy.

Main Methods:

  • Identified patients undergoing laryngoscopy before endocrine surgery over five years.
  • Conducted a literature review to determine the prevalence of VCP in patients without risk factors.
  • Combined study data with published data to estimate the background rate of VCP and the risk of bilateral VCP.

Main Results:

  • 0.63% of patients (4/632) had unilateral VCP, all with voice symptoms or prior neck surgery.
  • Excluding patients with risk factors, the pre-existing VCP rate was 0.2%.
  • Omitting preoperative laryngoscopy in low-risk patients estimates a 1/50,000 to 1/150,000 risk of bilateral VCP.

Conclusions:

  • Selective use of laryngoscopy before thyroidectomy is sufficient.
  • Routine laryngoscopy for all patients is not necessary due to acceptably low statistical risk.