Table 2. Discussion Points for the Surgeon/Patient Educator
Preoperative discussions
Surgeon should inquire if the patient has had any voice change or hoarseness prior to surgical
intervention.
Surgeon/educator should complete a voice assessment preoperatively.
Surgeon/educator should discuss with patient the risk factors for voice change following
thyroid surgery. For example, in patients with a large multinodular goiter, known extra-
thyroidal extension or re-operation in an area of previous neck surgery, thyroidectomy may
increase the risk of voice change.
Surgeon/educator should discuss with the patient possible surgical risks as they relate to the
potential for voice change following thyroidectomy. ese risks may include injury to the
RLN, EBSLN, from division of the strap muscles, and potential intubation trauma.
Surgeon/educator should discuss the potential benefits and need for preoperative
laryngoscopy.
Surgeons who use intraoperative nerve monitoring should discuss with patients the rationale
for use and the potential that second side surgery might not be completed in planned bilateral
cases based on information gained from monitoring.
Postoperative discussions
Patients should be instructed to notify their providers if voice change (breathiness,
hoarseness, decreased exercise tolerance, or increased vocal effort) lasts for >2 weeks.
Patients should have an assessment of their voice postoperatively.
Patients should be counseled that there are techniques to potentially improve voice, if
necessary, following thyroid surgery and that early recognition of persistent voice change is
important to success.
Table 3. Preoperative Factors that May Be Associated with
Extrathyroidal Extension in Patients with a Preoperative
Diagnosis of Thyroid Malignancy
Historical factors: voice abnormality, dysphagia, airway symptoms, hemoptysis, pain,
rapid progression
Physical exam factors: large or firm mass, mass fixed to the larynx or trachea
Radiographic factors
a
(typically ultrasound and/or CT or MR):
irregular or blurred borders or extension of the mass to the periphery of a thyroid lobe,
especially posterior extension
a
Note: imaging studies may be negative for invasion in patients with extrathyroidal extension.
