Multimodal Patterns of Early Voice Change After Thyroidectomy

Voice change after thyroidectomy may occur even without overt vocal fold paralysis. This study explored patterns of early postoperative change across patient-reported, acoustic, functional, and stroboscopic measures.

This single-center retrospective study included 120 patients who underwent thyroidectomy and completed preoperative and early postoperative voice assessments at postoperative day 7 ± 2 days. Patients with preexisting voice disorders or overt vocal fold paralysis were excluded. Assessments included the thyroidectomy-related voice and symptom questionnaire, acoustic analysis, maximum phonation time, voice range profile, and videolaryngostroboscopy. Postoperative change variables were directionally harmonized, standardized, and summarized into symptom, acoustic, functional, and stroboscopic domain scores for exploratory K-means clustering.

An exploratory three-cluster solution comprised cluster A, with lower relative deterioration (66 patients, 55.0%); cluster B, with marked acoustic and stroboscopic deterioration (8 patients, 6.7%); and cluster C, with symptom and functional deterioration with limited acoustic change (46 patients, 38.3%). Cluster A showed less deterioration relative to the cohort average, although symptoms and pitch range also worsened. Cluster B showed the greatest worsening in shimmer, noise-to-harmonic ratio, edema, and bowing. Cluster C showed prominent symptom and pitch-range deterioration with comparatively small changes in noise-to-harmonic ratio and bowing. The exploratory association of female sex with combined B/C membership does not establish biological susceptibility.

Exploratory clustering described differing profiles of early post-thyroidectomy voice change across routinely obtainable clinical voice measures. These profiles should be interpreted as descriptive early postoperative patterns rather than fixed diagnostic or prognostic categories. Further longitudinal and external validation is needed.