{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:17:23Z","timestamp":1779110243103,"version":"3.51.4"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of intraoperative neuromonitoring (IONM), hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time-course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Data were prospectively recorded in a single-center clinical quality assurance registry (June 2015 to May 2016) and subsequently analyzed retrospectively, with a 12-month follow-up for all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ear\u2013nose\u2013throat (ENT) specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruitment from June 2015 to May 2016) that included structured telephone interviews every 4\u20136 weeks to assess the exact time course of PT-VCD recovery and VC status for a period of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6\/2015 to 5\/2016 there were 1097 consecutive thyroid procedures. During this period, 78 cases of PT-VCD (1591 nerves at risk (NARs); 4.9%) were entered into the detailed follow-up-program. Of these, three cases of PT-VCD persisted at 12 months (PT-VCD 0.18% NAR), with six cases lost to follow-up (maximum rate of potentially persistent PT-VCD of 0.54% NAR). In total, 15% of PT-VCD cases recovered within 4 weeks; the mean recovery time was 4.4 months, and 6 months after thyroidectomy, 18% still had impaired VCL tests. Individual cases were followed &gt;12 months showing late full recovery of PT-VCD, thereby challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks: 0.39; 95%CI 0.15\u20130.98; p = 0.046) and more specifically, secondary ntLOS, to be a significant independent predictor of PT-VCP recovery beyond 12 weeks (OR for recovery within 12 weeks 0.303; 95%CI 0.115\u20130.797; p = 0.016). Conclusions: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort, along with correlations to operative data and IONM findings. Our study indicates that recovery from PT-VCD can be prolonged, and specifically, the occurrence of ntLOS\u2014especially secondary ntLOS\u2014during IONM was predictive of a longer recovery trajectory. This suggests that IONM may offer an additional advantage by functioning as a prognostic tool, helping to identify patients at higher risk for extended recovery periods. Such early identification could enable a more targeted approach, potentially allowing for the earlier initiation of supportive interventions, like speech therapy, in those most likely to benefit from proactive management.<\/jats:p>","DOI":"10.3390\/jcm15103844","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recovery Takes Time: Loss of Signal Predicts Delayed Recovery of Vocal Cord Function After Thyroidectomy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7414-693X","authenticated-orcid":false,"given":"Laura","family":"Guglielmetti","sequence":"first","affiliation":[{"name":"Departement of Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sina","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Departement of Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmin","family":"Al-Hammoud","sequence":"additional","affiliation":[{"name":"Departement of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Senne","sequence":"additional","affiliation":[{"name":"Departement of General, Visceral and Transplant-Surgery, University of T\u00fcbingen, 72076 Tubingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Busch","sequence":"additional","affiliation":[{"name":"Departement of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Wagner","sequence":"additional","affiliation":[{"name":"Departement of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Harsch","sequence":"additional","affiliation":[{"name":"Outcomes Research Unit, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7799-4099","authenticated-orcid":false,"given":"Andreas","family":"Zielke","sequence":"additional","affiliation":[{"name":"Departement of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-3167","authenticated-orcid":false,"given":"Constantin","family":"Smaxwil","sequence":"additional","affiliation":[{"name":"Departement of Endocrine Surgery, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s00268-003-6903-1","article-title":"Complications of thyroid surgery: Analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years","volume":"28","author":"Rosato","year":"2004","journal-title":"World J. 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