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We aimed to evaluate if an intraoperative signal recovery (ISR) after LOS may predict a positive outcome of VCM. Among 5884 consecutive intermittent IONM-guided thyroidectomies (April 2021- March 2025) all the patients in whom a LOS was observed were evaluated. Topic and intravenous corticosteroids were administered to all of them. Eventual recovery was evaluated after 20\u00a0minutes. Patients with\u00a0 an\u00a0ISR\u00a0less than\u00a0\u200950% compared to the\u00a0baseline were included. The rate of vagal signal (VS)\u00a0ISR was defined as a percent from the minimum value: VS-recovery\u2013VS-minimal\/VS-predissection\u2013VS-minumum. ISR was correlated to VCM (ROC curve analysis). Among 169 patients with LOS, 65 (38.5%) showed ISR, with 48 (73.8%) of them\u00a0exhibiting normal VCM on postoperative day 1 (POD-1). The remaining 17 patients with impaired VCM\u00a0on POD-1 recovered normal VCM on POD-15 (7\u201310.8%) or POD-30 (10\u201315.4%). The AUC for impaired VCM at POD-1 was 0.938 (95% CI: 0.849\u20130.983, p\u2009&lt;0.0001) and the ISR cut-off was 13%, with a 94.1% sensitivity and a 89.6% specificity. All patients with ISR\u2009&gt;31% showed normal VCM. All patients with ISR\u2009&lt;13% exhibited impaired motility at POD-15 but recovered at POD-30. ISR can predict full recovery of VCM. ISR\u2009&gt;31% is associated with normal postoperative VCM and staged thyroidectomy could be avoided in this subgroup of patients with LOS.<\/jats:p>","DOI":"10.1007\/s13304-025-02373-0","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T02:46:09Z","timestamp":1755657969000},"page":"2173-2181","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Partial intraoperative signal recovery is associated with normal postoperative vocal cord motility in patients with intraoperative loss of signal"],"prefix":"10.1007","volume":"77","author":[{"given":"Pierpaolo","family":"Gallucci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla Francesca","family":"Procopio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-700X","authenticated-orcid":false,"given":"Francesco","family":"Pennestr\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Marincola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"D\u2019Alatri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Martullo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"De Crea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Raffaelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"2373_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01655238","author":"JK Harness","year":"1986","unstructured":"Harness JK, Thompson NW, Burney RE, Mcleod MK (1986) Total thyroidectomy: complications and technique. 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Pierpaolo Gallucci, Priscilla Francesca Procopio and Francesco Pennestr\u00ec have a consultant agreement with Medtronic. Carmela De Crea, Giuseppe Marincola, Lucia D'Alatri and Annamaria Martullo declare that they have no conficts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This article does not contain any studies with animals performed by any of the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Informed consent was obtained from all individual participants for whom identifying information is included in this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}