Utility of Intraoperative Neurophysiological Monitoring in Thyroid Surgeries


  • India Blake School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
  • Jorge Lopez School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
  • Haley Puryear School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
  • Kelly Williams School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
  • Seniha Yildirim School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.
  • Faisal R. Jahangiri Global Innervation LLC, Dallas, Texas, USA; Department of Neuroscience, School of Behavioral & Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA; 3Labouré College of Healthcare, Milton, Massachusetts, USA. https://orcid.org/0000-0002-1342-1977




vagus nerve, RLN, SLN, recurrent laryngeal nerve, superior laryngeal nerve, EMG, CoMEP, Corticobulbar MEP, Thyroid


With the ultimate objective of reducing nerve injury, considering the uniqueness of each surgery to accommodate the patient best relies heavily on the intricacies presented within the surgery coupled with an understanding of when and how to implement monitoring. Thyroid and parathyroid surgeries present significant risks to patient outcomes, with the most frequent postoperative deficits resulting from injury to the vagal nerve and the recurrent laryngeal nerve (RLN). While visual identification has historically been used, the potential of permanent vocal cord damage necessitates new methods. As these nerves are particularly susceptible to insult during these procedures, we sought to establish the connection between IONM and analyze the role it plays in the reduction of these deficits.

Advantages alongside limitations of IONM were considered as we compared the success rates of nerve function retention and instances in which it was reported that monitoring did not produce ideal outcomes. The implications of these findings suggest that IONM aids in the early determination of damage, allowing clinicians the opportunity to make revisions that prevent loss and best preserve the integrity of nerves following procedures. Proper application of developing protocols should influence physicians' decisions of utilizing IONM techniques in the most advantageous way to the case, amending surgical strategy when needed.


Dighe, M., Barr, R., Bojunga, J., Cantisani, V., Chammas, M. C., Cosgrove, D., Cui, X. W., Dong, Y., Fenner, F., Radzina, M., Vinayak, S., Xu, J. M., & Dietrich, C. F. (2017). Thyroid Ultrasound: State of the Art Part 1 – Thyroid Ultrasound reporting and Diffuse 2. Motos-Micó, J. J., Felices-Montes, M., & Abad-Aguilar, T. (2017). Neuromonitorización intraoperatoria en cirugía tiroidea. Cirugía y Cirujanos, 85(4), 312–319.

Pardal-Refoyo, J. L., Parente-Arias, P., Arroyo-Domingo, M. M., Maza-Solano, J. M., Granell-Navarro, J., Martínez-Salazar, J. M., Moreno-Luna, R., & Vargas-Yglesias, E. (2018). Recommendations on the Use of Neuromonitoring in Thyroid and Parathyroid Surgery. Acta Otorrinolaringologica (English Edition), 69(4), 231–242. DOI: 10.1016/j.otoeng.2017.06.017.

Choi, S. Y., & Son, Y. I. (2019). Intraoperative Neuromonitoring for Thyroid Surgery: The Proven Benefits and Limitations. Clinical and Experimental Otorhinolaryngology, 12(4), 335–336. DOI: 10.21053/ceo.2019.00542.

Schneider, R., Sekulla, C., Machens, A., Lorenz, K., Nguyen Thanh, P., & Dralle, H. (2015). Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. British Journal of Surgery, 102(11), 1380–1387. DOI: 10.1002/bjs.9889.

Barczyński, M., Randolph, G. W., Cernea, C. R., Dralle, H., Dionigi, G., Alesina, P. F., Mihai, R., Finck, C., Lombardi, D., Hartl, D. M., Miyauchi, A., Serpell, J., Snyder, S., Volpi, E., Woodson, G., Kraimps, J. L., & Hisham, A. N. (2013). External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. The Laryngoscope, 123, S1–S14. DOI: 10.1002/lary.24301. 7. Barczyński, M., Konturek, A., Pragacz, K., Papier, A., Stopa, M., & Nowak, W. (2013). Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study. World Journal of Surgery, 38(3), 599–606. DOI: 10.1007/s00268-013-2260-x.

Leow YG, Lee CC, Gan JY, Huang LM. Comparison of Outcomes of Intra-operative Neuromonitoring of Recurrent Laryngeal Nerve Versus Visualisation Alone during Thyroidectomies: A Singapore Experience. Ann Acad Med Singap. 2020 Nov;49(11):870-875. DOI: 10.47102/annals-acadmedsg.2020132.

Cirocchi R, Arezzo A, D'Andrea V, Abraha I, Popivanov GI, Avenia N, Gerardi C, Henry BM, Randolph J, Barczyñski M. Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery. Cochrane Database Syst Rev. 2019 Jan 19;1(1):CD012483. DOI: 10.1002/14651858.CD012483.pub2.

Del Rio P, Cozzani F, Puteo N, Loderer T, Rossini M, Bonati E. IONM and thyroidectomy in benign thyroid disease. Analysis of adverse events. G Chir. 2019 May-Jun;40(3):174-181.

Kim SY, Kim SM, Makay Ö, Chang H, Kim BW, Lee YS, Park CS, Chang HS. Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients. Surg Endosc. 2020 Dec;34(12):5414-5420. doi: 10.1007/s00464-019-07336-2.

Ritter, A., Ganly, I., Wong, R. J., Randolph, G. W., Shpitzer, T., Bachar, G., & Mizrachi, A. (2020). Intraoperative nerve monitoring is used routinely by a significant majority of head and neck surgeons in thyroid surgery and impacts on extent of surgery—Survey of the American Head and Neck Society. Head & Neck, 42(8), 1757–1764.

Princi P, Gallo G, Tempera SE, Umbriano A, Goglia M, Andreoli F, Nigro C. The impact of intraoperative "Nerve Monitoring" in a tertiary referral center for thyroid and parathyroid surgery. Front Surg. 2022 Aug 10;9:983966. DOI: 10.3389/fsurg.2022.983966.

Marti, J. L., Holm, T., & Randolph, G. (2015). Universal Use of Intraoperative Nerve Monitoring by Recently Fellowship-Trained Thyroid Surgeons is Common, Associated with Higher Surgical Volume, and Impacts Intraoperative Decision-Making. World Journal of Surgery, 40(2), 337–343. DOI: 10.1007/s00268-015-3238-7.

Dionigi G, Chiang FY, Dralle H, Boni L, Rausei S, Rovera F, Piantanida E, Mangano A, Barczyński M, Randolph GW, Dionigi R, Ulmer C. Safety of neural monitoring in thyroid surgery. Int J Surg. 2013;11 Suppl 1: S120-6. DOI: 10.1016/S1743-9191(13)60031-X.

Calò PG, Medas F, Conzo G, Podda F, Canu GL, Gambardella C, Pisano G, Erdas E, Nicolosi A. Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified? Int J Surg. 2017 May;41 Suppl 1:S13-S20. DOI: 10.1016/j.ijsu.2017.02.001.

Kartal, K., Aygun, N., Celayir, M. F., Besler, E., Citgez, B., Isgor, A., & Uludag, M. (2020). Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy. Ear, Nose & Throat Journal, 014556132090632. DOI:10.1177/0145561320906325.

Thomusch, O., Sekulla, C., Machens, A., Neumann, H. J., Timmermann, W., & Dralle, H. (2004). Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbeck’s Archives of Surgery, 389(6), 499–503. DOI: 10.1007/s00423-003-0444-9.

Yang, T. F., Wang, J. C., Hsu, S. P., Lee, C. C., Lin, C. F., Chiu, J. W., Lai, C. J., Chan, R. C., & Lee, S. S. (2015). Localization of the cricothyroid muscle under ultrasound guidance for vagal nerve mapping. Journal of Clinical Anesthesia, 27(3), 252–255. DOI; 10.1016/j.jclinane.2015.01.002.




How to Cite

Blake, I., Lopez , J., Puryear, H., Williams , K., Yildirim , S., & Jahangiri, F. R. (2023). Utility of Intraoperative Neurophysiological Monitoring in Thyroid Surgeries. J of Neurophysiological Monitoring, 1(2), 28–36. https://doi.org/10.5281/zenodo.10214449

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