{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:40:23Z","timestamp":1787841623884,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"publisher","award":["NSTC 113\u20102314\u2010B\u2010037\u2010033\u2010MY2"],"award-info":[{"award-number":["NSTC 113\u20102314\u2010B\u2010037\u2010033\u2010MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"publisher","award":["NSTC 114\u20102314\u2010B\u2010037\u2010074"],"award-info":[{"award-number":["NSTC 114\u20102314\u2010B\u2010037\u2010074"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"publisher","award":["NSTC115\u20102314\u2010B\u2010037\u2010082"],"award-info":[{"award-number":["NSTC115\u20102314\u2010B\u2010037\u2010082"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council of Taiwan","doi-asserted-by":"publisher","award":["NSTC115\u20102314\u2010B\u2010037\u2010081"],"award-info":[{"award-number":["NSTC115\u20102314\u2010B\u2010037\u2010081"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004694","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":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to investigate the impact of elevated preoperative thyroid autoantibodies, a proposed non\u2010neural contributor, on postoperative voice outcomes, specifically within a cohort of patients undergoing nerve\u2010preserved thyroidectomy verified by intraoperative neuromonitoring (IONM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis included 212 patients who underwent primary nerve\u2010preserved thyroidectomy with IONM\u2010confirmed integrity of recurrent and superior laryngeal nerves. Patients were categorized into elevated antibody (EA) and normal antibody (NA) groups according to thyroglobulin antibody (TgAb) and anti\u2010thyroid microsomal antibody (TMAb) levels. Objective and subjective voice analyzes (VHI, VRQoL, and IVST) were performed pre\u2010 and postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The EA group had a significantly higher proportion of bilateral surgeries, larger tumors, and heavier specimens. Several postoperative voice parameters differed significantly between the two groups, and after adjustment for patient characteristics, EA levels remained independently associated with abnormal shimmer (adjusted OR 2.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021) and abnormal IVST\u2010T (adjusted OR 2.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). In the antibody\u2010grade analysis, a preliminary non\u2010linear pattern between antibody burden and postoperative voice outcomes was observed in shimmer, IVST\u2010T, and IVST\u2010S.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective exploratory study, elevated thyroid autoantibodies were associated with poorer objective voice stability and greater subjective voice impairment following IONM\u2010verified nerve\u2010preserved thyroidectomy. With standardized IONM minimizing the influence of major neural injury, these findings highlight a potential non\u2010neural influence of thyroiditis on postoperative dysphonia. Shimmer and IVST are useful indicators for detecting subtle functional changes, supporting thyroid antibody status as a practical serological indicator for individualized perioperative counseling and rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70549","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:14:23Z","timestamp":1787663663000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Nerves: Thyroid Autoimmunity as a Non\u2010Neural Factor for Post\u2010Thyroidectomy Dysphonia"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2185-1318","authenticated-orcid":false,"given":"Chih\u2010Hao","family":"Liu","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu\u2010Tang","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-9034","authenticated-orcid":false,"given":"Shih\u2010Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin\u2010Yi","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology, School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing\u2010Hei Viola","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Chu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9168-5858","authenticated-orcid":false,"given":"Jia Joanna","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6429-9038","authenticated-orcid":false,"given":"Cheng\u2010Hsun","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Gangshan Hospital Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leong\u2010Perng","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Otorhinolaryngology, School of Post\u2010Baccalaureate Medicine and School of Medicine, College of Medicine Kaohsiung Medical University  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