How Bad Will My Voice Be After Thyroid Surgery?

Thyroid surgery (and parathyroid surgery) are known as being high-risk surgeries for those who rely on their voice. So how bad will your voice be after thyroid surgery?

In the 1930s, a famous opera singer, Amelita Galli-Curci was noted to have an enlarged thyroid. After a number of tests were performed, it was determined that her goiter was beginning to affect her voice and was compressing her windpipe. She eventually underwent thyroid surgery... and then had to retire when her voice did not return to normal.

While there is much controversy surrounding her case, it is clear that thyroid surgery can have an outsized impact on the career of those who rely heavily on their voice. In addition to singers, those who are teachers, professionals, or anyone who earns their living through communication (most of us!) can be affected by a thyroid surgery that doesn't go according to plan.

When patients ask how bad their voice will be after thyroid surgery, I compare the results to the results of other common surgeries: for example, if I were to have an arthroscopic knee surgery, I would be able to return to work as a surgeon almost immediately. If I were a high performing athlete, on the other hand, I would likely require months of rehab before I was confident to return to the highest levels of my abilities.

Thyroid surgery can be thought of the same way: most of us will return to work with little to no significant disturbance to our voice after thyroid surgery. It may feel dry and scratchy for a couple of weeks and it might fatigue quickly, but those things recover and most people you talk to won't notice that there is anything different with your voice.

For those who have occupations that rely on their voice (and especially with singers or performers), it can be a different story. Because these patients are actually "vocal athletes," we usually recommend the same steps that we would offer any high level athlete in any other field. This can include voice therapy after surgery, adjusting schedules to minimized demands on the voice for some period of time after surgery, and even voice coaching. While not all patients require these steps, having them in place can be the difference between depression and hope for those who rely on their voice.

The final elephant in the room is about complications during surgery. One of the most feared complications during thyroid surgery can result in patients nearly completely losing their voice in some cases. Fortunately, those cases are rare with high volume thyroid surgeons, and there are things that can be done even in the worst case scenario. But in these situations, the voice will never be the same.

When you are choosing your surgeon, their experience is the single most important variable to protect your voice. Nationwide, rates of permanent voice injury can be anywhere from 1-10% depending on your surgeon. You should ask your surgeon what their specific rate of injury is and when the last time they permanently injured a the nerve was. And you should definitely ask them how many thyroid surgeries they have done. I've done thousands of thyroid and parathyroid surgeries at this point, and my nerve injury rates are about 10x lower than those of other busy thyroid surgeons.

Finally, as almost an aside, I have found in my practice that voice outcomes seem to be subtly better at the first follow up visit for those who have had "scarless" transoral thyroid surgery when compared to those who have had traditional surgery. Some have hypothesized that this could be due to less manipulation of the other muscles of the neck. While I can't be certain, I am grateful to say that after nearly 1000 "scarless" thyroid surgeries that I have done, I still do not have a single patient who has had a permanent injury to the nerve that moves the voice box. While my normal outcomes are excellent, I have started to offer this "scarless" approach slightly more to those who are especially worried about their voice. At a minimum, I can confidently tell these patients that "scarless" surgery will not be worse than traditional thyroid surgery... and "scarless" transoral thyroid surgery may actually be better.

In conclusion, if someone asks you "how much will my voice be affected by thyroid surgery?" you can tell them that most patients do very well... and that they can help themselves have the best outcome possible by looking for a surgeon who has done thousands of thyroid and parathyroid surgeries.