{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T17:57:57Z","timestamp":1764784677161,"version":"3.41.2"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>The objective of this study is to evaluate electromyographic waveforms related to vagus monitoring. We collected data from patients undergoing thyroidectomy with CIONM, regardless of vocal cord response amplitude initially measured. We divided data of 193 nerves into three groups, according to initial amplitude value: \u2265500 \u00b5V (Group 1,110 pt.), between 100 and 500 \u00b5V (Group 2, 79 pt.), and &amp;lt;100 \u00b5V (Group 3, 4 pt.). ROC curve showed a high diagnostic accuracy of final amplitude absolute value in vocal cord paralysis detection in both groups (89 and 86%). An increase of vocal cord paralysis risk was associated with progressive amplitude reduction (Group 1: OR=1.05, CI=1.02\u20131.09, p=0.001; Group 2: OR=1.05, CI=1.02\u20131.08, p=0.002). Cut-off values for amplitude reduction with optimal sensitivity and specificity were \u221277% in Group 1 and \u221215% in Group 2. In Group 3 signals showed an amplitude &amp;lt;100 \u00b5V for all monitoring, with no loss of a recognizable signal and normal postoperative cordal functionality. The use of a strict amplitude signal cut-off value \u2265500 \u00b5V could be too restrictive. Also, signal with baseline amplitude &amp;lt;500 \u00b5V may be considered equally adequate. Setting the alarm for a reduction of 77% in patients with initial amplitude \u2265500 \u00b5V and of 15% for those &amp;lt;500 \u00b5V could make monitoring safe and an effective aid for surgeons. In conclusion, there are cases in which initial amplitude is lower than that considered as adequate by current literature but with well recognizable and stable EMG waveforms. How those cases should be approached and what should the surgeon\u2019s attitude be are a matter of discussion.<\/jats:p>","DOI":"10.3389\/fendo.2021.714699","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T15:18:37Z","timestamp":1628003917000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Continuous Intraoperative Nerve Monitoring in Thyroid Surgery: Can Amplitude Be a Standardized Parameter?"],"prefix":"10.3389","volume":"12","author":[{"given":"Sara","family":"Mazzone","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelaide","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Giacomarra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2008.01875.x","article-title":"Diagnosis of Recurrent Laryngeal Nerve Palsy After Thyroidectomy: A Systematic Review","volume":"63","author":"Jeannon","year":"2009","journal-title":"Int J Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviscsurg.2013.04.003","article-title":"Complications After Total Thyroidectomy","volume":"150","author":"Christou","year":"2013","journal-title":"J Visc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"6674","DOI":"10.1097\/MD.0000000000006674","article-title":"Recurrent Laryngeal Nerve Injury After Thyroid and Parathyroid Surgery: Incidence and Postoperative Evolution Assessment","volume":"96","author":"Joliat","year":"2017","journal-title":"Med (Baltimore)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0049","article-title":"American Thyroid Association Statement on Outpatient Thyroidectomy","volume":"23","author":"Terris","year":"2013","journal-title":"Thyroid"},{"key":"B5","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.27359","article-title":"International Neural Monitoring Study Group Guideline 2018 Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal","author":"Schneider","year":"2018","journal-title":"Laryngoscope"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for Adult Patients With Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003580","article-title":"The American Association of Endocrine Surgeons Guidelines Forthe Definitive Surgical Management of Thyroid Disease in Adults","volume":"271","author":"Patel","year":"2020","journal-title":"Ann Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: Internationalstandards Guideline Statement","author":"Randolph","year":"2011","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200201000-00022","article-title":"Advantages of Recurrent Laryngeal Nerve Identification in Thyroidectomy and Parathyroidectomy and the Importance of Preoperative and Postoperative Laryngoscopic Examination in More Than 1000 Nerves at Risk","volume":"112","author":"Steurer","year":"2002","journal-title":"Laryngoscope"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24550","article-title":"Continuous Vagal IONM Prevents Recurrent Laryngeal Nerve Paralysis by Revealing Initial EMG Changes of Impending Neuropraxic Injury: A Prospective, Multicenter Study","volume":"124","author":"Phelan","year":"2014","journal-title":"Laryngoscope"},{"key":"B11","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1055\/s-0030-1262697","article-title":"Continuous Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery (CIONM): Where Are We Now? 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