Vocal fold function
A careful evaluation of the proposed outpatient thyroid surgery patient for dysphonia, dyspnea, or dysphagia with aspiration in the preoperative and immediate postoperative period should be part of the surgeon's checklist. Early identification of unilateral vocal fold paralysis permits a thorough evaluation to optimize the functional outcome for the patient (67,68). Recognition may be either by inability to stimulate the nerve at the completion of the thyroidectomy or by postoperative laryngoscopy before discharge. If the nerve is anatomically intact, eventual recovery of vocal function may be anticipated, and the patient and family/friend can be counseled on drinking maneuvers to avoid aspiration, such as taking liquids in small amounts through a straw while the chin is tilted down and to the side of the injury. Some patients might require inpatient care until they can tolerate oral intake. Patients experiencing any dyspnea at rest after thyroidectomy should not be discharged until undergoing fiberoptic laryngoscopy to evaluate for bilateral vocal fold paralysis, and documenting full recovery from the dyspnea.