{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:34:16Z","timestamp":1791909256488,"version":"4.3.4"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec id=\"ab-ooi240022-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Use of intraoperative neuromonitoring (IONM) during thyroidectomy can nearly eliminate the risk of postoperative bilateral vocal cord palsy (VCP) by indicating staged surgery in cases of loss of signal (LOS) on the first side of planned total thyroidectomy. However, aborting planned total thyroidectomy may lead to persistence of symptoms, delay in adjuvant treatment, and patient inconvenience and distress. There are few data to guide a selective approach to total thyroidectomy in patients with first-side LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate outcomes of immediate bilateral surgery in patients undergoing total thyroidectomy with first-side LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study was a retrospective review of outcomes for patients undergoing thyroidectomy between January 2016 and July 2023 at an academic tertiary referral center for thyroid surgery. Consecutive patients scheduled for total thyroidectomy using IONM were included. Exclusion criteria were preoperative VCP, deliberate sacrifice of recurrent laryngeal nerve (RLN), inadvertent RLN resection, and surgery performed without IONM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Total thyroidectomy performed using IONM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-8\">\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Vocal mobility on first postoperative day as assessed by flexible laryngoscopy; secondary outcome measures included subjective voice assessment, other postoperative complications, and long-term vocal mobility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 400 patients undergoing planned total thyroidectomy (mean age, 50.5 years [range, 4-88 years]; 318 female [79.5%]), 51 (12.8%) had first-side LOS, of whom 37 (9.3%) had persistent LOS. Twenty-nine patients (56% of procedures with first-side LOS, including 18 with persistent LOS) proceeded to immediate total thyroidectomy. Postoperatively, 16 patients (55% of patients undergoing total thyroidectomy following first-side LOS, including 14 of 18 with persistent LOS) had impaired vocal mobility. One patient had bilateral VCP that did not require tracheostomy, and 2 had postoperative hypoparathyroidism. Of those whose surgery was aborted after first-side LOS, 8 of 22 (36%) underwent completion thyroidectomy at a later stage. In those undergoing completion thyroidectomy, 2 of 8 (25%) had temporary VCP after the second surgery, 2 (25%) had permanent hypoparathyroidism, and 1 (12.5%) developed inoperable cancer. Postoperative VCP was fully reversible in all but 1 patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi240022-10\">\n                    <jats:title>Conclusion and Relevance<\/jats:title>\n                    <jats:p>Among patients planned for total thyroidectomy who develop first-side LOS, immediate total thyroidectomy may be considered among those who have pressing reasons for same, and where surgical difficulties might be anticipated in a secondary surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2024.0698","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T11:34:47Z","timestamp":1714044887000},"page":"509","source":"Crossref","is-referenced-by-count":14,"title":["Outcomes of Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal"],"prefix":"10.1001","volume":"150","author":[{"given":"Sruthi","family":"Ramesh","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia H.","family":"Van Den Berg","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Sheahan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland"},{"name":"ENTO Research Unit, College of Medicine and Health, University College, Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"ooi240022r1","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/j.surg.2008.02.006","article-title":"The mechanism of recurrent laryngeal nerve injury during thyroid surgery\u2013the application of intraoperative neuromonitoring.","volume":"143","author":"Chiang","year":"2008","journal-title":"Surgery"},{"issue":"6","key":"ooi240022r2","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1007\/s00268-016-3415-3","article-title":"Severity of recurrent laryngeal nerve injuries in thyroid surgery.","volume":"40","author":"Dionigi","year":"2016","journal-title":"World J Surg"},{"issue":"1","key":"ooi240022r3","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1002\/hed.v43.1","article-title":"Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy.","volume":"43","author":"Thong","year":"2021","journal-title":"Head Neck"},{"issue":"1","key":"ooi240022r4","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.surg.2017.03.029","article-title":"Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? 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