It Sometimes Happens: Staging Surgery in Coexisting Graves Disease and Thyroid Cancer

Thyroidectomy is a safe procedure often performed either for benign or malignant thyroid diseases. Complication rate is low and bilateral recurrent laryngeal nerve (RLN) injury associated with thyroidectomy is rarely described. The RLN may be injured bilaterally and damage is usually recognized postoperatively. With an increased use of intraoperative neural monitoring (IONM), an adaptation of the resection strategy appears to be necessary in case of an intraoperative loss of signal of the first operated side with total thyroidectomy planned. We review a case of a 21-year-old female with a history of Graves disease who underwent a total thyroidectomy in a 2-stage procedure due to a loss of RLN function detected intraoperatively. The patient recovered uneventfully from the 2 surgeries.