{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:34:14Z","timestamp":1791909254980,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T00:00:00Z","timestamp":1533772800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["KMUH106\u20106R49"],"award-info":[{"award-number":["KMUH106\u20106R49"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 106\u20102314\u2010B\u2010037\u2010042\u2010MY2"],"award-info":[{"award-number":["MOST 106\u20102314\u2010B\u2010037\u2010042\u2010MY2"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The increasing use of intraoperative neuromonitoring (IONM) in thyroid surgery has revealed the need to develop new strategies for cases in which a loss of signal (LOS) occurs on the first side of a planned total thyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study reviews the experience of the authors in using IONM for planned total thyroidectomy after LOS on the first thyroid lobe. The aims were to estimate the incidence of LOS on the first side of resection and to compare intraoperative strategies applied after this event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Intermittent IONM was performed with stimulation of both the vagal nerve and the recurrent laryngeal nerve (RLN) (V1, R1, R2, V2). Patients underwent pre\u2010 and postoperative laryngoscopy. Before surgery, patients were informed that staged thyroidectomy might be required.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study analyzed 803 consecutive thyroid procedures. Of these, V2 LOS (&lt;100 mcV) occurred after first lobe exeresis in 23 (2.8%) procedures. The surgical procedure was stopped in 20 cases (ie, staged thyroidectomy was performed). In three cases with malignancy and severe comorbidity (ASA score 3\u20104), total bilateral thyroidectomy was performed as planned. No cases of bilateral RLN palsy occurred. Postoperative laryngoscopy confirmed RLN palsy in 21 of the 23 cases. All true positive patients received speech therapy. Patients who had false positive LOS (n\u2009=\u20092) or malignancy (n\u2009=\u20098) and patients who were symptomatic (n\u2009=\u20097) received completion thyroidectomy within 6 months. One patient received radioactive iodine therapy for hyperthyroidism. Two patients received follow up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neuromonitoring changes the surgical decision\u2010making process in a multidisciplinary manner. A shared decision\u2010making process involving the patient, anesthesiologist, and endocrinologist is suggested. In the case of intraoperative LOS on the first\u2010operated side in a planned total thyroidectomy, the thyroid surgeon essentially has three options for surgery on the contralateral side: 1) Perform staged thyroidectomy. This option is recommended in bilateral goiter, Graves' disease, or low\u2010risk thyroid carcinoma (differentiated or medullary thyroid carcinoma). The aim is to avoid bilateral vocal cord palsy. Two\u2010stage completion surgery is delayed until recovery of ipsilateral nerve function. 2) Perform subtotal resection on the contralateral side ventrally to the RLN plane at a safe distance from the nerve. The aim is to avoid further disease recurrence and revision surgery. 3) Perform total thyroidectomy as planned for advanced thyroid carcinoma (including undifferentiated thyroid carcinoma). The aim is to improve disease control through radioactive iodine therapy, radiation therapy, or target therapy immediately after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.171","type":"journal-article","created":{"date-parts":[[2018,8,9]],"date-time":"2018-08-09T09:57:17Z","timestamp":1533808637000},"page":"326-332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Staged Thyroidectomy: A Single Institution Perspective"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-5348","authenticated-orcid":false,"given":"Che\u2010Wei","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Kaohsiung Municipal Hsiao\u2010Kang Hospital  Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"the College of Medicine  Kaohsiung Medical University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Sun","sequence":"additional","affiliation":[{"name":"the Jilin Provincial Key Laboratory of Surgical Translational Medicine  China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, China\u2010Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine Changchun Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Zhang","sequence":"additional","affiliation":[{"name":"the Jilin Provincial Key Laboratory of Surgical Translational Medicine  China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, China\u2010Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine Changchun Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoon Yub","family":"Kim","sequence":"additional","affiliation":[{"name":"the KUMC Thyroid Center Korea University  Anam Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonina","family":"Catalfamo","sequence":"additional","affiliation":[{"name":"the Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d  University Hospital G. Martino, University of Messina Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Portinari","sequence":"additional","affiliation":[{"name":"the Department of Surgery  S. Anna University Hospital Ferrara Italy"},{"name":"the Department of Morphology, Surgery, and Experimental Medicine  University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Carcoforo","sequence":"additional","affiliation":[{"name":"the Department of Surgery  S. Anna University Hospital Ferrara Italy"},{"name":"the Department of Morphology, Surgery, and Experimental Medicine  University of Ferrara Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"the Department of Otolaryngology\u2013Head and Neck Surgery  Harvard Medical School Boston Massachusetts U.S.A."},{"name":"the Division of Thyroid and Parathyroid Endocrine Surgery  Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A."},{"name":"the Division of Surgical Oncology, Department of Surgery  Massachusetts General Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-3433","authenticated-orcid":false,"given":"Young Jun","family":"Chai","sequence":"additional","affiliation":[{"name":"Department of Surgery  Seoul National University Seoul Metropolitan Government Boramae Medical Center Dongjak\u2010gu Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0864-6087","authenticated-orcid":false,"given":"Gianlorenzo","family":"Dionigi","sequence":"additional","affiliation":[{"name":"the Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood \u201cG. 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