Pre-Operative Evaluation for Thyroidectomy

Voice Assessment and Documentation

The American Academy of Otolaryngology-Head and Neck Surgery recommends that all patients undergoing thyroidectomy should have a preoperative voice assessment and vocal fold mobility examination, with formal laryngoscopy required for any patient with voice impairment, suspected extrathyroidal extension, prior neck surgery, or thyroid malignancy 1, 2
A preoperative voice assessment should be performed on every patient to establish baseline function and enable postoperative comparison, using audio recording in a quiet environment with microphone within 4 cm of patient's mouth 1, 2, 3
The assessment should include recording sustained "ah" and "ee" for 3-5 seconds each, standard sentences, and 30-60 seconds of conversational speech, with a HIPAA-compliant smartphone recording being acceptable if professional equipment is unavailable 2, 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends examining vocal fold mobility in patients with any voice impairment, suspected extrathyroidal extension, prior neck surgery, or thyroid malignancy 1, 4
Vocal fold paralysis occurs in 1% of benign thyroid disease and up to 8% of malignant disease, and strongly suggests invasive malignancy (>70% in invasive cancer vs 0.3% in noninvasive disease) 2, 7, 8

One-third of patients with postoperative vocal fold paralysis are asymptomatic, making examination more reliable than symptoms alone 5, 6
Preoperative knowledge of vocal fold paralysis enables more detailed surgical planning, imaging, and patient counseling 8, 9

The American Academy of Otolaryngology-Head and Neck Surgery recommends educating all patients about potential voice changes after thyroid surgery, including discussing recurrent laryngeal nerve injury rates: 0-5% for nerve-sparing surgery, 13% for cancer operations, 30% for revision surgery 4, 5, 6

The American Academy of Otolaryngology-Head and Neck Surgery recommends not relying solely on voice symptoms to determine the need for laryngoscopy, as up to 68% of vocal fold paralysis cases may be asymptomatic 5, 6
Flexible laryngoscopy is superior to mirror examination for detecting subtle vocal fold motion abnormalities and allows video documentation 7, 8, 9