Hernia and 
General Surgeon  
02380 178 991 

Advise from Consultant Surgeon Mr James Kirkby-Bott

Voice Change post Thyroid and Parathyroid Surgery

Voice change can occur after any type of neck operation including thyroid and parathyroid surgery. Usually, it is due to damage to a nerve (recurrent laryngeal nerve) running just under the thyroid gland to the voice box. It can make the voice weak and difficult to project. It will also tire quicker than usual so that towards the end of your day it can be harder to speak audibly.


We have a very innovative machine we use routinely in these surgeries that monitors the wave form being conducted along the nerve continually throughout the procedure. This wave form can change in shape as we manipulate the gland to do your surgery. It alters its wave form in response to ‘stress’ that might stop it from functioning a long time before the function of the nerve is altered. By making a continuous monitoring of this nerve function (cIONM) we can alter what we do before a functional voice change occurs. It also means we do not need to put a camera down your nose once awake during routine follow up to visualise this nerve function. Before using this machine, voice change affected up to 20% of patients, of which 90% was temporary.


If you have experienced some change in your voice, we suggest you take some time to build it up again. It is useful to visualize this injury as if you have injured a muscle – when first healing, it likes some rest. Then it likes to have activity re-introduced and built up gradually.

Not all voice change is related to the function of this nerve. The ‘sound’ and ‘resonance’ of your voice was never related solely to vocal cord function. In essence, thyroid and parathyroid surgery never improves your voice. It may always sound a little different after surgery if the voice resonance is altered by removing a large lump (some thyroid surgeries). The aim is not to damage your recurrent laryngeal nerve.

Recurrent laryngeal nerve damage affects more than just voice. It will also affect your swallow that can feel different, and it can also mean you aspirate fluids or even saliva at times making you cough. This kind of nerve injury can increase recurrent chest infections and cause chronic lung disease that can reduce your life span by up to 10 years on average. This is why we take such efforts with cIONM to help reduce this risk as far as possible. The risk is <1%.

Voice Strengthening Exercises

Follow the exercise below for your voice when you feel ready to strengthen your voice again.
Vowel Sounds

Make vowel sounds and then try and say ‘e’ and hold it for as long as you can with a single breath.

Time yourself. How long did the sound last? If it lasts for more than 10 seconds you’re doing really well or back to normal.

Blow Bubbles

Using a straw and a glass of water blow bubbles through the straw into the water for as long as you can make each breath last.

Maximising Your Voice

Press the side of your neck firmly and talk. Then do the same on the other side. Try and work out if pressing one side improves your voice. If it does then the nerve on the side pressed is the side injured.

A useful tip if socialising: try sitting to the side of someone you want to talk so that you have to twist your head to the side of the injured nerve when talking. It will make your voice stronger and last for longer.

All of Mr Kirkby-Bott's outcomes are recorded on the National Database of Endocrine surgery outcomes run by the British Association of Endocrine and Thyroid Surgery

Click here to see Mr Kirkby-Bott's outcomes