Diagnosis
Key Action Statements
Preoperative Management
Î BASELINE VOICE ASSESSMENT: The surgeon should document
assessment of the patient's voice once a decision has been made to
proceed with thyroid surgery. (R-C)
Î PREOPERATIVE LARYNGEAL ASSESSMENT OF THE IMPAIRED VOICE:
The surgeon should examine vocal fold (VF) mobility (or refer the patient
to a clinician who can examine VF mobility) if the patient's voice is
impaired (as determined by the assessment in Table 1) and a decision
has been made to proceed with thyroid surgery. (R-C)
Î PREOPERATIVE LARYNGEAL ASSESSMENT OF THE NONIMPAIRED
VOICE: Once a decision has been made to proceed with thyroid surgery,
the surgeon should examine VF mobility (or refer the patient to a
clinician who can examine VF mobility) if the patient's voice is normal
and the patient has:
a. thyroid cancer with suspected extrathyroidal extension and/or
b. prior neck surgery that places at risk the recurrent laryngeal or vagus
nerve (eg, carotid endarterectomy, anterior approach to the cervical
spine, cervical esophagectomy, and prior to thyroid or parathyroid
surgery).
Î PATIENT EDUCATION ON VOICE OUTCOMES: The clinician should
educate the patient about the potential impact of thyroid surgery on
voice once a decision has been made to proceed with thyroid surgery.
(R-B)
Î COMMUNICATION WITH ANESTHESIOLOGIST: The surgeon should
inform the anesthesiologist of the results of abnormal preoperative
laryngeal assessment in patients who have had laryngoscopy prior to
thyroid surgery. (R-C)
