Persistent Voice Changes Following Total Thyroidectomy Despite Intraoperative Nerve Monitoring: A Retrospective...

This study aimed to determine the incidence of postoperative voice changes following total thyroidectomy and to characterize these changes in patients with documented intact intraoperative nerve monitoring (IONM), while comparing outcomes between surgeries performed with and without IONM.

This single-center retrospective observational study included 480 patients who underwent total thyroidectomy between 2015 and 2025. Among them, 350 patients had surgery performed with IONM, while 130 underwent the procedure without it. Postoperative voice changes were documented, and all patients with voice complaints underwent laryngoscopic evaluation to assess vocal cord mobility and exclude recurrent laryngeal nerve (RLN) injury. Descriptive statistics and comparative analyses were used to evaluate correlations within the data.

Postoperative voice alterations were reported in 4 (0.83%) patients, all of whom were in the IONM group. In each case, intraoperative and postoperative assessments confirmed no injury to the RLN. These voice changes resolved spontaneously within 3-4 months without specific intervention. No patients in the non-IONM group reported any voice complaints. The difference in the prevalence of postoperative voice change between the IONM and non-IONM groups was not statistically significant (p > 0.05).

This study demonstrated a low incidence of symptomatic postoperative voice changes following total thyroidectomy, with transient dysphonia resolving spontaneously in all affected patients. The occurrence of voice changes in the IONM group was not statistically significant and likely reflects differences in surgical complexity rather than the effect of monitoring itself. Larger prospective multicenter studies incorporating standardized objective voice assessments are warranted to clarify postoperative voice outcomes further.