Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review

Int J Clin Pract. 2009 Apr;63(4):624-9. doi: 10.1111/j.1742-1241.2008.01875.x.


Background: Recurrent laryngeal nerve palsy (RLNP) is a recognised possible complication after thyroid surgery. It may present with a variety of symptoms, such as voice change and respiratory symptoms. However, it may remain undetected and the true incidence may be under-reported. The aim of this study was to determine the reported incidence of temporary and permanent palsy after thyroid surgery using different vocal assessment methods.

Methods: A Medline search was performed. A systematic review was undertaken which included 27 articles and 25,000 patients.

Results: The average incidence of temporary RLNP after thyroid operations is 9.8% and the incidence of permanent RLNP is 2.3%. The RLNP rate varied according to the method of examining the larynx and ranged from 26% to 2.3%. Most of the reviewed studies recommend a follow-up period up to 1 year to assess and evaluate RLNP.

Conclusion: Our study has identified that different methods are used to diagnose RNLP and that a wide variety of reported RLNP rates exist. We propose establishment of a 'gold standard' for assessing the voice after thyroidectomy to reduce reporting bias.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Laryngoscopy
  • Recovery of Function
  • Sensitivity and Specificity
  • Stroboscopy
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / adverse effects*
  • Thyroidectomy / methods
  • Vocal Cord Paralysis / diagnosis*
  • Vocal Cord Paralysis / etiology