Taking Care of Your Voice Before, During and After Thyroid Surgery

Hi, I’m Dr. James Wu, an endocrine surgeon at UCLA Health. If you’re preparing for thyroid surgery—or recovering from one—there’s a good chance you’re thinking about your voice. That’s a really common concern, and today I want to talk about how we protect your voice during surgery, what you can do before and after surgery, and why understanding the anatomy around the thyroid—especially the nerves—is so important to preserving your voice.

Let’s start with what’s at stake.

Your thyroid gland sits low in the front of your neck, and running just behind it are two important nerves called the recurrent laryngeal nerves. These nerves control the movement of your vocal cords. If one of these nerves is injured during surgery, it can cause hoarseness, breathiness, or even trouble swallowing or projecting your voice. That’s why protecting the recurrent laryngeal nerves is one of our top priorities during thyroid surgery.

But there’s another nerve that doesn’t get talked about as much, and it’s just as important—especially for people who use their voice professionally. That’s the external branch of the superior laryngeal nerve.

This nerve controls the cricothyroid muscle, which helps tighten the vocal cords to produce higher pitch and vocal projection. If that nerve is injured—even if your vocal cords are still moving normally—you might notice that your voice feels weaker, fatigues easily, or that you can’t hit high notes if you’re a singer. You may not be hoarse, but your voice just doesn’t feel the same.

That’s why, we’re not only protecting the recurrent laryngeal nerves—we’re also very careful about identifying and preserving the external branch of the superior laryngeal nerve during surgery. We do this with a combination of careful dissection and surgical experience, and nerve monitoring when appropriate. Preserving both nerves is essential to giving you the best chance at a full voice recovery after surgery.

So, what can you do before surgery?

If you're a singer, teacher, public speaker, or professional voice user, it’s important to tell your surgeon up front. In some cases, we may recommend a pre-operative laryngoscopy, which is a quick procedure that lets us check your vocal cords and voice function before we even start. That gives us a baseline and helps guide the surgery plan. We can also have a thoughtful discussion about the right amount of surgery for the problem you are facing, because less surgery equals less risk to the nerves that control your voice.

Now, let’s talk about what to expect after surgery.

Even in the best-case scenario, it’s not uncommon to have some temporary voice changes in the days or weeks after surgery. You might feel a little hoarse, or like your voice tires out more quickly. That’s often due to normal swelling or irritation from the breathing tube used during anesthesia—not from nerve damage—and it typically improves on its own.

To help with recovery, I recommend:

1. Voice rest in the first few days—avoid shouting or whispering
2. Hydration—drink plenty of water to keep your vocal cords healthy
3. Avoiding irritants like smoking or excessive caffeine
4. And using your voice gently as it starts to come back

If you notice persistent symptoms—especially changes in pitch, vocal strength, or range—we may refer you to a laryngologist or voice therapist. Many of these changes can be improved with voice therapy, and if needed, there are also procedures that can help restore normal voice function.

The bottom line is: Your voice matters, whether you're a singer or just want to speak clearly and confidently. And preserving it starts with expert care during surgery.

To summarize:

• The recurrent laryngeal nerve controls vocal cord movement—we monitor and protect it closely
• The external branch of the superior laryngeal nerve helps with pitch and projection—it’s just as important, especially for voice professionals
• Let your surgeon know if you use your voice professionally—we can do a pre-op voice exam if needed
• After surgery, expect some mild hoarseness or fatigue—it’s usually temporary
• Rest, hydrate, and let us know if symptoms persist—we’re here to help

If you’re preparing for thyroid surgery and want to talk more about your voice, we’d love to meet with you. Visit us at endocrinesurgery.ucla.edu, or call us at 310-267-7838 to schedule a consultation.

I’m Dr. James Wu—thanks for watching, and I’ll see you next time.

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