Each individual has two pairs of voice nerves one on each side of wind pipe and behind the thyroid gland. These are recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN). These nerves maintain tone, pitch and quality of our voice. There are various symptoms that patient may face in case of injury to these nerves like:

• One side damage to recurrent laryngeal nerve produces hoarseness of voice and aspiration of food.
• Both side injury to recurrent laryngeal nerve produces difficulty in breathing and voice loss and sometimes patient may need emergency tracheostomy.
• Injury to EBSLN produces voice fatigue and loss of high pitch sound.

An expert surgeon identifies each branch of these nerves and separate it from the thyroid tissue meticulously so as to preserve normal voice. Studies have shown that rate of nerve injury in the hands of the high volume thyroid surgeon is less as compared to the low volume thyroid surgeon. Similarly rate of nerve injury is more in cases of reoperation, so it is important to find a dedicated thyroid surgeon, to minimize the risk of nerve injury. In certain case scenario, intra-operative nerve monitoring can be used to decrease the incidence of nerve injury.