12
Treatment
Recommendation 23
A. Visual identification of the RLNs should be performed during
thyroidectomy and/or para-tracheal node dissection, to preserve
nerve integrity and function. (GPS)
B. Intraoperative neurophysiological monitoring of the recurrent
laryngeal nerve(s) may be performed during thyroidectomy for
malignancy in an effort to reduce the risk of RLN injury, particularly
during total or re-operative thyroidectomy. (C-L/M)
C. Intraoperative identification and neurophysiological monitoring of
the external branch of the superior laryngeal nerve (EBSN) may
be performed during thyroidectomy for malignancy in an effort to
improve accurate nerve identification and improve voice outcomes.
(C-M/H)
D. Intraoperative vagal nerve or proximal RLN stimulation (with
monitoring or laryngeal palpation) should be performed after initial
lobectomy to assess RLN integrity and function prior to removing the
contralateral lobe in an effort to avoid possible bilateral nerve injury.
(GPS)
Recommendation 24
A. The parathyroid glands and their blood supply should be preserved
during thyroid surgery to reduce the risk of hypoparathyroidism.
Parathyroid glands, if devascularized or removed, should be auto-
transplanted into nearby muscle after frozen section (of a portion)
confirms benign parathyroid tissue. (GPS)
B. After total thyroidectomy and/or central lymph node dissection, or
after unilateral operations that follow prior contralateral thyroid
resections, parathyroid hormone-directed calcium and vitamin D
supplementation (regular or selective) should be provided to reduce
rates of hypocalcemia and shorten hospital stays compared to
observation with serial calcium measurement alone. (S-M)
Recommendation 25
➤ Under most circumstances, drainage of the thyroidectomy bed is not
recommended; it is associated with increased length of stay, may
increase infections, and does not reduce the incidence of hematoma.
(C-H)
