Original Research Article| Volume 223, ISSUE 5, P923-926, May 2022

Effectiveness of early administration of a single dose of steroids and escin after loss of signal on electromyographic signal recovery during neuromonitored thyroidectomy

Published:October 14, 2021DOI:


      • The impact of a single administration of dexamethasone plus escin on the recovery of LOS during neuromonitored total thyroidectomy has been evaluated.
      • A first group of patients did not receive any drug administration, a second group received an early administration of dexamethasone plus escin after LOS.
      • LOS was recovered in 11 of 37 (29.7%) patients in Group 1, and in 23 of 35 (65.7%) patients in Group 2 (p < 0.001).
      • Early administration of dexamethasone plus escin upon detection of LOS may achieve greater EMG signal recovery than the wait and see technique.



      The aim of this study was to evaluate the effect of a single early administration of dexamethasone and escin after loss of signal (LOS) during a neuromonitored total thyroidectomy.


      A retrospective analysis of results concerning consecutive patients undergoing total thyroidectomy was performed. Patients included in the study were divided into two groups: Group 1 for which a “wait and see” strategy was used; Group 2, receiving dexamethasone and escin immediately after LOS detection.


      Overall 37 patients were included in Group 1 and 35 in Group 2. LOS recovery occurring in 29.7% of cases (n. 11) versus 65.7% (n. 23) respectively (p < 0.001). Postoperative fibrolayngoscopy for patients without LOS recovery showed normal cord function in 4 out of 26 cases (15.4%) in Group 1 and in 7 out of 12 (58.3%) in Group 2 (p < 0.001).


      The early administration of dexamethasone and escin after LOS detection may achieve greater EMG signal recovery than a “wait and see” strategy.


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        • Hermann M.
        • Alk G.
        • Roka R.
        • et al.
        Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk.
        Ann Surg. 2002; 235: 261-268
        • Barczynski M.
        • Konturek A.
        • Pragacz K.
        • et al.
        Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: results of a retrospective cohort study.
        World J Surg. 2014; 38: 599-606
        • Dralle H.
        • Sekulla C.
        • Lorenz K.
        • et al.
        Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery.
        World J Surg. 2008; 32: 1358-1366
        • Stopa M.
        • Barczynski M.
        Prognostic value of intraoperative neural monitoring of the recurrent laryngeal nerve in thyroid surgery.
        Langenbeck’s Arch Surg. 2017; 402: 957-964
        • Fiorentino E.
        • Cipolla C.
        • Graceffa G.
        • et al.
        Local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngopharyngitis.
        Eur Arch Oto-Rhino-Laryngol. 2011; 268: 715-720
        • Cipolla C.
        • Macaione I.
        • Vieni S.
        • et al.
        Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy.
        Eur Arch Oto-Rhino-Laryngol. 2021; 278: 1577-1583
        • Schneider R.
        • Sekulla C.
        • Machens A.
        • et al.
        Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function.
        Head Neck. 2016; 38: E1144-E1151
        • Dralle H.
        • Lorenz K.
        • Machens A.
        Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions.
        Head Neck. 2012; 34: 1591-1596
        • Randolph G.W.
        • Dralle H.
        • Group wtIIMS
        • et al.
        Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.
        Laryngoscope. 2011; 121: S1-S16
        • Chandrasekhar S.S.
        • Randolph G.W.
        • Seidman M.D.
        • et al.
        Clinical practice guideline: improving voice outcomes after thyroid surgery.
        Otolaryngol Head Neck Surg. 2013; 148: S1-S37
        • Schneider R.
        • Randolph G.W.
        • Dionigi G.
        • et al.
        International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal.
        Laryngoscope. 2018; 128: S1-S17
        • Graceffa G.
        • Patrone R.
        • Vieni S.
        • et al.
        Association between hashimoto’s thyroiditis and papillary thyroid carcinoma: a retrospective analysis of 305 patients.
        BMC Endocr Disord. 2019; 19: 26
        • Serpell J.W.
        • Woodruff S.
        • Bailey M.
        • et al.
        Recurrent laryngeal nerve diameter increases during thyroidectomy.
        Ann Surg Oncol. 2011; 18: 1742-1747
        • Pedram M.
        • Castagnera L.
        • Carat X.
        • et al.
        Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone.
        Eur Spine J. 2003; 12: 84-90
        • Dombrowski M.E.
        • Morales-Restrepo A.
        • Fourman M.S.
        • et al.
        Prophylactic perioperative dexamethasone decreases the incidence of postoperative C5 palsies after a posterior cervical laminectomy and fusion.
        Spine J. 2018; 19: 253-260
        • Gokaslan Z.L.
        • Bydon M.
        • De la Garza-Ramos R.
        • et al.
        Recurrent laryngeal nerve palsy after cervical spine surgery: a multicenter AOSpine clinical research network study.
        Global Spine J. 2017; 7: 53S-57S
        • Zou Z.
        • Jiang Y.
        • Xiao M.
        • Zhou R.
        The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy: a systematic review and meta-analysis.
        PLoS One. 2014; 9e109582
        • Kim J.S.
        • Kwon S.H.
        • Lee S.E.
        • et al.
        Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy. A meta-analysis.
        Medicine. 2018; 97e11832
        • Cheng S.P.
        • Liu T.P.
        • Yang P.S.
        • et al.
        Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review.
        Langenbeck's Arch Surg. 2015; 400: 929-936
        • Wang L.F.
        • Lee K.W.
        • Kuo W.R.
        • et al.
        The efficacy of intraoperative corticosteroids in recurrent laryngeal nerve palsy after thyroid surgery.
        World J Surg. 2006; 30: 299-303
        • Gallelli L.
        Escin: a review of its anti-edematous, antiinflammatory, and venotonic properties.
        Drug Drug Des Devel Ther. 2019; 13: 3425-3437
        • Domanski D.
        • Zegrocka-Stendel O.
        • Perzanowska A.
        • et al.
        Molecular mechanism for cellular response to β-escin and its therapeutic implications.
        PLoS One. 2016 Oct 11; 11e0164365
        • EMA
        Assessment Report on Aesculus Hippocastanum L., Semen.
        European Medicines Agency London, 2009
        • Gallelli L.
        • Cione E.
        • Wang T.
        • Zhang L.
        Glucocorticoid-like activity of escin: a new mechanism for an old drug.
        Drug Des Dev Ther. 2021; 15: 699-704
        • Cipolla C.
        • Vieni S.
        • Genova P.
        • et al.
        Value of neurostimulation plus laryngeal palpation to predict postoperative vocal fold motility.
        J Surg Res. 2021; 267: 506-511
        • Schneider R.
        • Randolph G.
        • Dionigi G.
        • et al.
        Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: the International Neural Monitoring Study Group's POLT study.
        Laryngoscope. 2016; 126: 1260-1266
        • Sitges-Serra A.
        • Gallego-Otaegui L.
        • Fontané J.
        • et al.
        Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring.
        Br J Surg. 2019; 106: 404-411
        • Goretzki P.E.
        • Schwartz K.
        • Brinkmann J.
        • et al.
        The impact of intraoperative neuromonitoring (IONM) on surgical strategy in bilateral thyroid disease: is it worth the effort?.
        World J Surg. 2010; 34: 1274-1284
        • Xin W.
        • Zhanga L.
        • Sun F.
        • et al.
        Escin exerts synergistic anti-inflammatory effects with low doses of glucocorticoids in vivo and in vitro.
        Phytomedicine. 2011; 18: 272-277
        • Zhang L.
        • Huang Y.
        • Wu C.
        • et al.
        Network pharmacology based research on the combination mechanism between escin and low dose glucocorticoids in anti-rheumatoid arthritis.
        Front Pharmacol. 2019; 10: 280
        • Du Y.
        • Song Y.
        • Zhang L.
        • et al.
        Combined treatment with low dose prednisone and escin improves the anti-arthritic effect in experimental arthritis.
        Int Immunopharm. 2016; 31: 257-265
        • Donatini G.
        • Danion J.
        • Zerrweck C.
        • et al.
        Single dose steroid injection after loss of signal (LOS) during thyroid surgery is effective to recover electric signal avoiding vocal cord palsy and the need of staged thyroidectomy: prospective evaluation on 702 patients.
        World J Surg. 2020; 44: 417-425