Effect of Electromyography Findings of Traction‐Related Signal Loss on Prognosis During Neuromonitored Thyroidectomy

Background Intraoperative neuromonitoring (IONM) is a reliable tool to detect electromyographic loss of signal (LOS). Here, we investigated the effect of electromyography features of traction‐related LOS on prognosis. Methods Thyroidectomy patients with a traction‐related LOS were included. The cases were divided into four groups as follows: Type 1 LOS with no amplitude (0 μV) (Group 1), Type 1 LOS with low‐amplitude (1–99 μV) (Group 2), Type 2 LOS with no amplitude (Group 3), and Type 2 LOS with low‐amplitude (Group 4). Results A total of 788 patients (1429 nerves) were analyzed. Traction‐related LOS was found in 74 patients (9.4%) and 77 nerves (5.4%). Intraoperative recovery was observed in 21 (48.8%) nerves in Group 4, and significantly higher ( p = 0.011). Vocal cord paralysis was less in Group 4 ( p = 0.001). Conclusions In traction‐related injury, electromyography features may contribute to the decision‐making process. Type 2 LOS with low‐amplitude is associated with a high likelihood of intraoperative recovery, potentially reducing the need for staged thyroidectomy.