Treatment
Key Action Statements
Î IDENTIFYING RLN: The surgeon should identify the RLN(s) during
thyroid surgery. (S-B)
Î PROTECTION OF SLN: The surgeon should take steps to preserve the
EBSLN(s) when performing thyroid surgery. (R-C)
Î INTRAOPERATIVE EMG MONITORING: The surgeon or a designee
may monitor laryngeal EMG during thyroid surgery. (O-C)
Î INTRAOPERATIVE CORTICOSTEROIDS: No recommendation can
be made regarding the impact of a single intraoperative dose of
intravenous corticosteroid on voice outcomes in patients undergoing
thyroid surgery. (N-D)
Î POSTOPERATIVE VOICE ASSESSMENT: The surgeon should
document whether there has been a change in voice between 2 weeks
and 2 months following thyroid surgery. (R-C)
Î POSTOPERATIVE LARYNGEAL EXAMINATION: Clinicians should
examine VF mobility or refer the patient for examination of VF
mobility in patients with a change in voice following thyroid surgery
(as identified above). (R-C)
Î OTOLARYNGOLOGY REFERRAL: The clinician should refer a patient
to an otolaryngologist when abnormal VF mobility is identified after
thyroid surgery. (R-C)
Î VOICE REHABILITATION: Clinicians should counsel patients with
voice change or abnormal VF mobility after thyroid surgery on
options for voice rehabilitation. (R-B)
Evidence Quality and Recommendation Grades
a
Evidence Quality Recommendation
Treatment and Harm Diagnosis Strength
A High-quality RCTs Systematic review of
consistent cross-sectional
studies
S Strong
recommendation
B Consistent RCTs Consistent individual
cross-sectional studies
R Recommendation
C Observational studies Nonconsecutive studies,
case-control studies, or
other studies of poor
quality
O Option
D Case reports, consensus opinions N None
X Exceptional situations with clear benefit
a
See full text guidelines for details.
