NO
Document baseline
assessment of patient's voice
Is the
patient's voice
impaired?
Monitor laryngeal
electromyography
(EMG) during surgery
Any change in
the patient's voice
between 2 weeks and
2 months following
surgery?
Patient aged ≥18 years
undergoing thyroid surgery
Option
A. Thyroid cancer with suspected
extrathyroidal extension
B. History of prior neck surgery
YES
Algorithm of Guideline's Key Action Statements
Does the
patient have:
A and/or B
Examine the patient's VF motion
or refer for examination
Educate patient about the
potential impact of thyroid
surgery on the voice
NO
Inform the anesthesiologist
of abnormal preoperative
laryngeal assessment
Identify the RLN during
thyroid surgery
Take steps to preserve
the EBSLN
YES
Document voice changes in the
patient's medical record
Examine VF mobility or
refer for examination
Abnormal
VF mobility?
Refer to an otolaryngologist
Counsel patient on options for
voice rehabilitation
Patient transitions to adjuvant
therapy or surveillance as indicated
by the underlying disease
YES
NO
NO
