R. Ranganath, Vaninder K. Dhillon, J. Russell, R. Tufano
Intraoperative nerve monitoring (IONM) is a validated and well accepted technology in open thyroid surgery. Intermittent and continuous neuromonitoring are the current technologies that are available. The International Neural Monitoring Group has established standards for the use of nerve monitoring in open surgery. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming common in high volume endocrine surgery centers. To be widely accepted the safety benchmarks set by open surgery for neuromonitoring have to be met. The evolution of use of IONM in endoscopic thyroid surgery, the current technique of IONM use in TOETVA, equipment used, advantages and disadvantages are discussed in this review.
{"title":"The evolution and progress of the application of intraoperative monitoring in endoscopic thyroid surgery","authors":"R. Ranganath, Vaninder K. Dhillon, J. Russell, R. Tufano","doi":"10.21037/aot.2018.11.01","DOIUrl":"https://doi.org/10.21037/aot.2018.11.01","url":null,"abstract":"Intraoperative nerve monitoring (IONM) is a validated and well accepted technology in open thyroid surgery. Intermittent and continuous neuromonitoring are the current technologies that are available. The International Neural Monitoring Group has established standards for the use of nerve monitoring in open surgery. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming common in high volume endocrine surgery centers. To be widely accepted the safety benchmarks set by open surgery for neuromonitoring have to be met. The evolution of use of IONM in endoscopic thyroid surgery, the current technique of IONM use in TOETVA, equipment used, advantages and disadvantages are discussed in this review.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44648811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prof. Ahuja has provided his insight into why he thinks Hong Kong has a very advanced system in developing the technologies of Head and Neck Imaging, he further elaborated the reason behind by comparing it with the system in India.
{"title":"Advanced system of head & neck imaging in Hong Kong","authors":"V. Wong","doi":"10.21037/AOT.2018.09.01","DOIUrl":"https://doi.org/10.21037/AOT.2018.09.01","url":null,"abstract":"Prof. Ahuja has provided his insight into why he thinks Hong Kong has a very advanced system in developing the technologies of Head and Neck Imaging, he further elaborated the reason behind by comparing it with the system in India.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49067600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Due to its role as a component of thyroid hormones, iodine is considered an essential nutrient. These hormones cross the placenta early in pregnancy and are essential for brain development and maturation of the fetus during early pregnancy. The critical period for this dependency extends from intrauterine life to 3 years of age. Iodine requirements increase dramatically during pregnancy and lactation. Pregnant and breastfeeding women need extra iodine to help ensure their iodine needs are met. Inadequate iodine intake during these period leads to insufficient production of thyroid hormones. Sever iodine deficiency has negative effects on normal physical growth and mental development of children, whereas the consequences of mild to moderate deficiency are less clear. The elimination of iodine deficiency is relatively simple and feasible through iodine supplementation. Among the many methods of prevention, iodized oil and salt iodization programs have been implemented in many countries. Since 1999, the number of countries with effective salt iodization as a safe, cost-effective, and sustainable strategy to ensure sufficient intake of iodine has increased to the point that today over 80% of the world has access to adequately iodized salt. Although iodized salt is commonly the main source of iodine for general populations, iodine supplements are recommended by different medical societies during pregnancy and lactation.
{"title":"Iodine nutrition in pregnancy","authors":"H. Delshad","doi":"10.21037/AOT.2018.08.01","DOIUrl":"https://doi.org/10.21037/AOT.2018.08.01","url":null,"abstract":"Due to its role as a component of thyroid hormones, iodine is considered an essential nutrient. These hormones cross the placenta early in pregnancy and are essential for brain development and maturation of the fetus during early pregnancy. The critical period for this dependency extends from intrauterine life to 3 years of age. Iodine requirements increase dramatically during pregnancy and lactation. Pregnant and breastfeeding women need extra iodine to help ensure their iodine needs are met. Inadequate iodine intake during these period leads to insufficient production of thyroid hormones. Sever iodine deficiency has negative effects on normal physical growth and mental development of children, whereas the consequences of mild to moderate deficiency are less clear. The elimination of iodine deficiency is relatively simple and feasible through iodine supplementation. Among the many methods of prevention, iodized oil and salt iodization programs have been implemented in many countries. Since 1999, the number of countries with effective salt iodization as a safe, cost-effective, and sustainable strategy to ensure sufficient intake of iodine has increased to the point that today over 80% of the world has access to adequately iodized salt. Although iodized salt is commonly the main source of iodine for general populations, iodine supplements are recommended by different medical societies during pregnancy and lactation.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.08.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid hormones of the fetus exclusively comes from mothers in early pregnancy, indicating that maternal hypothyroidism has a close-knit relationship with fetal growth and neuropsychological development. Hypothyroidism is one of the most common endocrinopathies during pregnancy with an estimated prevalence of 3–5% among pregnant women. Emerging evidence suggests that maternal overt hypothyroidism is associated with adverse maternal, obstetrical and neonatal outcomes, but, although there is still no consensus on the association of subclinical thyroid disorders or increasing thyroid antibodies with complications of pregnancy and childhood cognition. Data available are inconclusive regarding the benefits of treatment of subclinical hypothyroid pregnant women for both feto-maternal outcomes and even neurocognitive development of the children of affected women. In this review we aimed to address pregnancy outcomes of mothers affected by overt and subclinical hypothyroidism, psychosocial development of neonates affected by overt and subclinical maternal hypothyroidism and the beneficial effects of treatment.
{"title":"Hypothyroidism in pregnancy","authors":"F. Tehrani, S. Behboudi-Gandevani","doi":"10.21037/AOT.2018.08.02","DOIUrl":"https://doi.org/10.21037/AOT.2018.08.02","url":null,"abstract":"Thyroid hormones of the fetus exclusively comes from mothers in early pregnancy, indicating that maternal hypothyroidism has a close-knit relationship with fetal growth and neuropsychological development. Hypothyroidism is one of the most common endocrinopathies during pregnancy with an estimated prevalence of 3–5% among pregnant women. Emerging evidence suggests that maternal overt hypothyroidism is associated with adverse maternal, obstetrical and neonatal outcomes, but, although there is still no consensus on the association of subclinical thyroid disorders or increasing thyroid antibodies with complications of pregnancy and childhood cognition. Data available are inconclusive regarding the benefits of treatment of subclinical hypothyroid pregnant women for both feto-maternal outcomes and even neurocognitive development of the children of affected women. In this review we aimed to address pregnancy outcomes of mothers affected by overt and subclinical hypothyroidism, psychosocial development of neonates affected by overt and subclinical maternal hypothyroidism and the beneficial effects of treatment.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.08.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48421010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most controversial issue in the field of thyroid and pregnancy is whether clinicians should screen all pregnant women for thyroid disease, and the screening should be performed before pregnancy or at the first prenatal visit. This review aimed to discuss updates on the important issue of thyroid screening before conception and during pregnancy and to highlight the gap in evidence that has led to remarkable controversies on this topic. The terms “screening” AND “thyroid” AND “pregnancy” were used to search Medline for English-language papers published from 1990 to the end of January 2018. After reviewing of titles of 482 articles, we focused on high quality and important studies. With respect to the Wilson and Jungner criteria for disease screening, thyroid dysfunction screening before and during pregnancy is still a conflicting issue. Available data suggests that compared to the universal screening, the case finding screening would result in missing cases of thyroid dysfunction. The primary debate is regarding maternal, fetal and offspring benefits of treatment of mothers with subclinical hypothyroidism and/or thyroid autoimmunity. Results of few high-quality studies in this field are in favor of some benefit considering pregnancy outcomes but no significant beneficial impact on fetal and offspring outcomes. Likewise, cost-effectiveness studies support the concept of universal screening. More evidence is required to assess the advantages and disadvantages of two different screening strategies for thyroid dysfunction in pregnancy, focusing on maternal, neonatal and offspring health outcomes following diagnosis and treatment of thyroid dysfunction, especially subclinical hypothyroidism in pregnancy. Moreover, screening strategies need to be individualized for each country according to disease burden, case finding costs and available health services.
{"title":"Screening for thyroid dysfunction in pregnancy","authors":"A. Amouzegar, H. Abdi, M. Takyar","doi":"10.21037/aot.2018.06.02","DOIUrl":"https://doi.org/10.21037/aot.2018.06.02","url":null,"abstract":"The most controversial issue in the field of thyroid and pregnancy is whether clinicians should screen all pregnant women for thyroid disease, and the screening should be performed before pregnancy or at the first prenatal visit. This review aimed to discuss updates on the important issue of thyroid screening before conception and during pregnancy and to highlight the gap in evidence that has led to remarkable controversies on this topic. The terms “screening” AND “thyroid” AND “pregnancy” were used to search Medline for English-language papers published from 1990 to the end of January 2018. After reviewing of titles of 482 articles, we focused on high quality and important studies. With respect to the Wilson and Jungner criteria for disease screening, thyroid dysfunction screening before and during pregnancy is still a conflicting issue. Available data suggests that compared to the universal screening, the case finding screening would result in missing cases of thyroid dysfunction. The primary debate is regarding maternal, fetal and offspring benefits of treatment of mothers with subclinical hypothyroidism and/or thyroid autoimmunity. Results of few high-quality studies in this field are in favor of some benefit considering pregnancy outcomes but no significant beneficial impact on fetal and offspring outcomes. Likewise, cost-effectiveness studies support the concept of universal screening. More evidence is required to assess the advantages and disadvantages of two different screening strategies for thyroid dysfunction in pregnancy, focusing on maternal, neonatal and offspring health outcomes following diagnosis and treatment of thyroid dysfunction, especially subclinical hypothyroidism in pregnancy. Moreover, screening strategies need to be individualized for each country according to disease burden, case finding costs and available health services.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2018.06.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48453860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indeterminate cytology arises from the limit inherent in traditional cyto-morphological analysis. Numerous benign processes can cause subtle cellular or nuclear changes, sometimes indistinguishable from findings of well-differentiated carcinoma. Moreover, follicular carcinoma can be diagnosed only if the tumor’s ability to penetrate capsular or vascular structures is documented, but such a property can only be assessed at final histology.
{"title":"The dilemma of indeterminate thyroid cytology: how many markers are needed for a reliable diagnosis?","authors":"S. Sciacchitano, A. Bartolazzi","doi":"10.21037/AOT.2018.07.01","DOIUrl":"https://doi.org/10.21037/AOT.2018.07.01","url":null,"abstract":"Indeterminate cytology arises from the limit inherent in traditional cyto-morphological analysis. Numerous benign processes can cause subtle cellular or nuclear changes, sometimes indistinguishable from findings of well-differentiated carcinoma. Moreover, follicular carcinoma can be diagnosed only if the tumor’s ability to penetrate capsular or vascular structures is documented, but such a property can only be assessed at final histology.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.07.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49456180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Moleti, G. Sturniolo, M. Di Mauro, M. Russo, F. Vermiglio
Thyroid autoimmunity affects 5–20% of the female population of childbearing age. Even in the absence of overt maternal thyroid dysfunction, thyroid autoimmunity has been reported to be associated with an increased risk of adverse pregnancy outcomes and impaired fetal neurodevelopment. Present evidence indicates that thyroid autoimmunity poses a risk for miscarriage and preterm delivery. By contrast, with regard to infertility most studies failed to find significantly different likelihood of pregnancy in euthyroid women with and without thyroid antibodies undergoing assisted reproduction procedures. Finally, uncertainty surrounds the role of thyroid autoantibodies on fetal and neonatal outcomes, since an increased risk for perinatal death, intrauterine growth restriction (IUGR), and respiratory distress syndrome has been inconsistently reported, and only few studies addressed the impact of maternal thyroperoxidase antibodies (TPOAbs) during pregnancy on cognitive functioning of the child, once again providing mixed results. Whether thyroid antibodies have a direct effect on neonatal outcomes, including neurodevelopment in the progeny, or whether the observed associations are related to maternal autoimmune-related thyroid insufficiency needs to be still clarified.
{"title":"Autoimmune thyroid diseases and pregnancy","authors":"M. Moleti, G. Sturniolo, M. Di Mauro, M. Russo, F. Vermiglio","doi":"10.21037/AOT.2018.07.03","DOIUrl":"https://doi.org/10.21037/AOT.2018.07.03","url":null,"abstract":"Thyroid autoimmunity affects 5–20% of the female population of childbearing age. Even in the absence of overt maternal thyroid dysfunction, thyroid autoimmunity has been reported to be associated with an increased risk of adverse pregnancy outcomes and impaired fetal neurodevelopment. Present evidence indicates that thyroid autoimmunity poses a risk for miscarriage and preterm delivery. By contrast, with regard to infertility most studies failed to find significantly different likelihood of pregnancy in euthyroid women with and without thyroid antibodies undergoing assisted reproduction procedures. Finally, uncertainty surrounds the role of thyroid autoantibodies on fetal and neonatal outcomes, since an increased risk for perinatal death, intrauterine growth restriction (IUGR), and respiratory distress syndrome has been inconsistently reported, and only few studies addressed the impact of maternal thyroperoxidase antibodies (TPOAbs) during pregnancy on cognitive functioning of the child, once again providing mixed results. Whether thyroid antibodies have a direct effect on neonatal outcomes, including neurodevelopment in the progeny, or whether the observed associations are related to maternal autoimmune-related thyroid insufficiency needs to be still clarified.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.07.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68296968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid disease is the most common endocrine disorder affecting women of reproductive age. Accordingly, women with thyroid dysfunction who are considering pregnancy should have preconception counseling to review the status of their thyroid health with a focus on improving future pregnancy outcomes. Goals of the preconception counseling visit include optimizing control of thyroid function prior to conception with an emphasis on the use of effective interval contraception. Discussion of the effects of thyroid disease on pregnancy and the influence of pregnancy on thyroid disease are helpful in setting accurate expectations for the antepartum period. A review of the safety profile of all available treatment options including any potential maternal and fetal side effects should be undertaken. Targeted TSH screening, treatment of those with serum TSH >4.0 mU/L, adjustment of levothyroxine dosage to achieve TSH <2.5 mU/L in hypothyroid patients and a change of methimazole to propylthiouracil before conception have been recommended. Preconception counseling involves a multifaceted team approach to care with optimization of successful outcomes for the mother and her fetus.
{"title":"Preconception counseling for thyroid disorders","authors":"P. Aghajanian","doi":"10.21037/AOT.2018.07.02","DOIUrl":"https://doi.org/10.21037/AOT.2018.07.02","url":null,"abstract":"Thyroid disease is the most common endocrine disorder affecting women of reproductive age. Accordingly, women with thyroid dysfunction who are considering pregnancy should have preconception counseling to review the status of their thyroid health with a focus on improving future pregnancy outcomes. Goals of the preconception counseling visit include optimizing control of thyroid function prior to conception with an emphasis on the use of effective interval contraception. Discussion of the effects of thyroid disease on pregnancy and the influence of pregnancy on thyroid disease are helpful in setting accurate expectations for the antepartum period. A review of the safety profile of all available treatment options including any potential maternal and fetal side effects should be undertaken. Targeted TSH screening, treatment of those with serum TSH >4.0 mU/L, adjustment of levothyroxine dosage to achieve TSH <2.5 mU/L in hypothyroid patients and a change of methimazole to propylthiouracil before conception have been recommended. Preconception counseling involves a multifaceted team approach to care with optimization of successful outcomes for the mother and her fetus.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.07.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43139074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metastases to cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) are common and associated with up to 80% of PTC patients (1). Cervical LN metastasis itself has been known as a risk factor for recurrent/persistent disease and PTC with lateral cervical LN metastasis has a worse prognosis than that with central neck LN metastasis (2,3).
{"title":"Metastatic lymph node characteristics predicting prognosis of papillary thyroid cancer patients","authors":"M. Jeon, Y. Shong","doi":"10.21037/AOT.2018.06.01","DOIUrl":"https://doi.org/10.21037/AOT.2018.06.01","url":null,"abstract":"Metastases to cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) are common and associated with up to 80% of PTC patients (1). Cervical LN metastasis itself has been known as a risk factor for recurrent/persistent disease and PTC with lateral cervical LN metastasis has a worse prognosis than that with central neck LN metastasis (2,3).","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.06.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43041811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Schneider, A. Machens, G. Randolph, D. Kamani, Whitney Liddy, K. Lorenz, H. Dralle
Electrophysiological nerve mapping and monitoring devices have been forthcoming since the 1970s, facilitating intraoperative identification and functional checks of recurrent laryngeal nerve (RLN) function during neck surgery. Although the clinical importance of intraoperative nerve monitoring (IONM) has become obvious in the past two decades, the inability of intermittent IONM to seamlessly monitor RLN function as the dissection progresses in the neck has prevented more widespread application of this technology. With the advent of continuous IONM in the new millennium, unsupervised intervals during nerve monitoring have virtually ceased to exist, pushing the envelope further. Continuous IONM has taken our understanding of functional RLN injury to unprecedented levels. Remarkably, traction on the nerve causes distinct electromyographically changes appearing as loss of signal (LOS), which typically is reversible upon prompt release of the nerve. Continuous IONM (I) reflects nerve electrophysiology more accurately than intermittent IONM; (II) flags impending RLN injury earlier, yielding more lead time for corrective action; and (III) predicts early postoperative vocal cord palsy more reliably. The present review provides a comprehensive summary of the evolution and future perspectives of continuous IONM.
{"title":"Evolution and progress of continuous intraoperative neural monitoring","authors":"R. Schneider, A. Machens, G. Randolph, D. Kamani, Whitney Liddy, K. Lorenz, H. Dralle","doi":"10.21037/AOT.2018.09.02","DOIUrl":"https://doi.org/10.21037/AOT.2018.09.02","url":null,"abstract":"Electrophysiological nerve mapping and monitoring devices have been forthcoming since the 1970s, facilitating intraoperative identification and functional checks of recurrent laryngeal nerve (RLN) function during neck surgery. Although the clinical importance of intraoperative nerve monitoring (IONM) has become obvious in the past two decades, the inability of intermittent IONM to seamlessly monitor RLN function as the dissection progresses in the neck has prevented more widespread application of this technology. With the advent of continuous IONM in the new millennium, unsupervised intervals during nerve monitoring have virtually ceased to exist, pushing the envelope further. Continuous IONM has taken our understanding of functional RLN injury to unprecedented levels. Remarkably, traction on the nerve causes distinct electromyographically changes appearing as loss of signal (LOS), which typically is reversible upon prompt release of the nerve. Continuous IONM (I) reflects nerve electrophysiology more accurately than intermittent IONM; (II) flags impending RLN injury earlier, yielding more lead time for corrective action; and (III) predicts early postoperative vocal cord palsy more reliably. The present review provides a comprehensive summary of the evolution and future perspectives of continuous IONM.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2018.09.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47536128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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