Ten-year outcomes of standardized anatomy-based thyroidectomy without routine intraoperative neuromonitoring: A longitudinal cohort from a specialized endocrine surgery centre

Recurrent laryngeal nerve (RLN) dysfunction and postoperative calcium disturbance are key outcomes of thyroid surgery. We describe 10-year outcomes of a standardized anatomy-based programme in which intraoperative neuromonitoring (IONM) was not routinely used. This retrospective longitudinal cohort included 1,098 primary patients undergoing 1,124 eligible thyroid procedures from 2016 through 2025: 757 total thyroidectomies, 341 hemithyroidectomies, and 26 contralateral completion thyroidectomies, contributing 1,881 anatomical nerves at risk (NAR). Routine preoperative and postoperative laryngoscopy was used, with more than 98% postoperative completion. Six nerves with preoperative vocal fold dysfunction were excluded from incident laryngeal analyses, leaving 1,875 preoperatively functioning NAR. Transient postoperative vocal fold dysfunction occurred in 59/1,875 NAR (3.15%) and persistent dysfunction in 7/1,875 (0.37%). Bilateral dysfunction occurred in 4/1,098 patients (0.36%). Transient postoperative hypocalcaemia occurred in 71/1,098 patients (6.47%); 1 patient (0.09%) required calcium and/or active vitamin D supplementation at last follow-up (8–12 months). Return to theatre for bleeding was required after 16/1,124 procedures (1.42%). Transient dysfunction was detected in 26/853 NAR (3.05%) in 2016–2019 and 33/1,022 (3.23%) in 2020–2025 (odds ratio 1.06, 95% CI 0.63–1.79; Fisher exact p = 0.895). Standardized anatomy-based thyroid surgery within a specialized service was associated with low persistent laryngeal and calcium-related morbidity. Systematic laryngoscopy identified transient dysfunction that could be clinically silent. These results provide an institutional benchmark but do not establish equivalence or non-inferiority to IONM-assisted surgery.