The Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery was based on the current body of evidence regarding voice outcomes during thyroid surgery. As determined by the Guideline Development Group's review of of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:
- Investigate methods to avoid unnecessarily extensive or bilateral thyroid surgery, including methods to increase accuracy of FNAB in predicting malignancy.
- Investigate what patient subgroups are at highest risk for RLN paralysis at thyroidectomy.
- Determine how surgeons can learn maximally from their own surgical cases and complications.
- Develop learning tools for both patients and physicians to optimize shared decision making around the time of thyroidectomy.
- Further research on endotracheal tube size, shape, and cuff dynamics to optimize voice around the time of thyroidectomy or other general anesthetic requiring intubation.
- Further research on the current practices of surgeons during thyroidectomy including the number of cases
where the nerve is not identified.
- Further research on the utility of corticosteroids perioperatively, particularly their impact on voice outcomes.
- Evaluate patterns and utility of otolaryngology referral and treatment of vocal fold paralysis.