{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:33:19Z","timestamp":1793809999682,"version":"4.6.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"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:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-thyroidectomy voice change is common, but early postoperative objective voice-change patterns and their short-term clinical relevance remain insufficiently characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center prospective cohort study, patients undergoing thyroid surgery were screened consecutively from October 2025 to November 2025. Standardized voice recordings were obtained at baseline and postoperative day 2 (POD2), and clinical voice outcomes were assessed at postoperative day 7 (POD7). Five POD2 spectral change features relative to baseline were used to derive phenotypes through a prespecified two-stage unsupervised clustering workflow based on partitioning around medoids, Manhattan distance, and silhouette-based cluster-number selection. Clinical validation used change in Voice Handicap Index-30 (VHI-30), the prespecified VHI-30 responder definition (Delta VHI-30 \u2265 13), and change in Grade within the Grade, Roughness, Breathiness, Asthenia, Strain scale. Robustness was evaluated using consensus clustering, proportion of ambiguous clustering, sample-level stability, and resampling-based adjusted Rand index reproducibility. Sensitivity analyses compared the primary workflow with one-step k = 3 and k = 4 clustering alternatives, and exploratory analyses evaluated operative and demographic factors in relation to POD7 outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 401 screened patients, 245 were included in the final analytic cohort. The final phenotypes were A\/B\/C = 59\/56\/130. All five spectral clustering features differed significantly across phenotypes (all P &amp;lt; 0.001). At POD7, phenotypes differed significantly in VHI-30 change (epsilon-squared = 0.641), VHI-30 responder rate (Cram\u00e9r\u2019s V\u00a0=\u00a00.639), and Grade change (epsilon-squared = 0.203) (all P &amp;lt; 0.001). Phenotype B showed the greatest short-term burden, including a responder rate of 53.6% (30\/56; exact 95% confidence interval, 39.7%\u201367.0%), compared with 1.7% (1\/59; exact 95% confidence interval, 0.0%\u20139.1%) in phenotype A and 1.5% (2\/130; exact 95% confidence interval, 0.2%\u20135.4%) in phenotype C. Sensitivity analyses did not support replacing the prespecified two-stage workflow with one-step k = 3 or k = 4 alternatives. Exploratory analyses suggested that the clinical profile of phenotype B was not simply explained by thyroidectomy extent, surgical approach, lateral neck dissection, or operative time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early postoperative objective voice changes after thyroid surgery can be organized into clinically interpretable short-term phenotypes associated with patient-reported and supportive perceptual outcomes. These phenotypes should be interpreted as early postoperative voice-change patterns rather than as nerve-injury phenotypes or persistent long-term voice categories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1845546","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:25:45Z","timestamp":1781497545000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Early postoperative voice-change phenotypes after thyroid surgery: a prospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Heyang","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease","place":["Changchun, China"]},{"name":"Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease","place":["Changchun, China"]},{"name":"Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijie","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease","place":["Changchun, China"]},{"name":"Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma","place":["Changchun, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease","place":["Changchun, China"]},{"name":"Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yishen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease","place":["Changchun, China"]},{"name":"Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma","place":["Changchun, 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