***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Importance It is important that clinicians underst and consequences of thyoridectomy on swallowing from the patient perspective to better care for this population . Objective Using rigorous qualitative methodology , this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes . Design , Setting , and Participants Prospect i ve , grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy ( 2 weeks , 6 weeks , and 6 months ) . Data were collected from an ongoing clinical trial ( NCT02138214 ) , and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics . All participants were age 21 to 73 years with a diagnosis of papillary thyroid cancer without cervical or distant metastases and had undergone total thyroidectomy . Exclusion criteria were preexisting vocal fold abnormalities ( eg , polyps , nodules ) , neurological conditions affecting the voice or swallowing ability , and /or development of new-onset vocal fold paresis or paralysis ( lasting longer than 6 months ) after total thyroidectomy . Interventions Total thyroidectomy . Main Outcomes and Measures Symptoms of dysphagia and related effects on quality of life elicited through grounded theory analysis of semistructured interviews with patients after thyroidectomy design ed to foster an open-ended , patient-driven discussion . Results Of the 26 patients included , 69 % were women ( n = 18 ) ; mean ( SD ) age , 46.4 ( 14.1 ) years ; mean ( SD ) tumor diameter 2.2 ( 1.4 ) cm . Two weeks after thyroidectomy , 80 % of participants ( n = 20 ) reported at least 1 swallowing-related symptom when prompted by the interview cards ; during the open interview , 53 % of participants ( n = 14 ) volunteered discussion of swallowing-related symptoms unprompted . However , only 8 % of participants in this study ( n = 2 ) qualified for a follow-up dysphagia evaluation , indicating that the majority of reported symptoms were subjective in nature . Six weeks and 6 months after thyroidectomy , 42 % ( n = 11 ) and 17 % ( n = 4 ) of participants , respectively , reported continued swallowing symptoms using the prompts ; 12 % ( n = 3 ) discussed symptoms without prompting cards at both time points . Conclusions and Relevance Swallowing symptoms after thyroidectomy are underreported in the literature . This study revealed that as many as 80 % of patients who have thyroidectomy may experience swallowing-related symptoms after surgery , and many develop compensatory strategies to manage or reduce the burden of these symptoms . Considering the large number of individuals who may experience subjective dysphagia , preoperative counseling should include education and management of such symptoms HYPOTHESES Goiter is a surgically reversible cause of  positional dyspnea ( PD ) .  Substernal tracheal compression ( TC ) predicts PD relief after thyroidectomy ( Tx ) . DESIGN Retrospective analysis of a prospect i ve structured management algorithm . SETTING Endocrine surgery academic center . METHODS Before Tx , 1081 patients were queried about PD . Those patients with substernal goiter underwent computed tomography  , and their degree of TC was estimated as greatest percent reduction of transverse tracheal diameter . For 197 patients with PD , TC , or both ,  surgical outcomes  were examined with a mean follow- up of 12.6 months . After Tx , patients who carried the diagnosis of obstructive sleep apnea were referred for repeat sleep study evaluation . RESULTS Positional dyspnea was reported by 188 of 1081 patients , and after Tx the PD improved or resolved in 82.4 % . In the 151 patients with substernal goiter , TC was present on imaging in 97.2 % ; the mean ( range ) TC was 34 % ( 5%-90 % ) . Patients with TC had a high likelihood of PD ( 93.5 % ) . After substernal goiter resection , PD improved in stepwise association with total resected thyroid gl and weight . Improvement in PD was strongly predicted by both gl and weight of 100 g or more ( P.001 ) and by TC of 35 % or more ( P.01 ) . After Tx , 59 of 77 snorers ( 76.6 % ) reported improvement in snoring , 77.1 % of patients with obstructive sleep apnea reported improved PD , and 2 of 3 retested patients with obstructive sleep apnea demonstrated objective improvement in sleep study apnea-hypopnea index . CONCLUSIONS Resection of bulky goiter frequently improves PD , which in substernal goiter is highly associated with TC . Either PD or TC of 35 % or more prompt Tx . Goiter should be considered when obstructive sleep apnea is diagnosed Background Voice and swallowing alterations are common complaints after thyroidectomy , even in the absence of laryngeal nerve impairment . However , voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated . This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy . Methods The study prospect ively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast ( GUAB ) approach ( 50 cases ) or by conventional open thyroidectomy ( 61 cases ) from September 2009 to October 2010 .  Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively . Subjective voice and swallowing alterations were assessed by question naire preoperatively and then 1 day , 1 week , 1 month , 3 months , and 6 months postoperatively . In addition , objective acoustic voice analysis was performed using a Multidimensional Voice Program , with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week , 1 month , 3 months , and 6 months postoperatively . Results Subjective postoperative voice function was significantly better in the robotic group at 1 day , 1 month , and 3 months postoperatively than in the open group . The mean values of fundamental frequency , jitter , shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups . However , the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively . Subjective swallowing function did not differ between the two groups . Conclusion Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy . This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis ObjectiveS wallowing disorders are frequent complaints after  thyroidectomy  even in the absence of recurrent laryngeal nerve palsy . The aim of this study was to assess different symptoms in relation to laryngeal mobility following thyroidectomy . Material s and methods 53 patients ( mean age 52.4 ± 12.5 years ; 36 female ) with initially benign diagnosis and intact recurrent nerve functioning were prospect ively evaluated .  Laryngeal movement was analyzed by ultrasound preoperatively and 1 , 3 , and 6 months postoperatively . In addition , a dysphagia and voice-specific quality -of-life question naire was used . Results Mean laryngeal movement differed between genders preoperatively and postoperatively result ing in a recovery predominantly in women ( reduction of mobility at 1 , 3 , and 6 months postoperatively in females was 6.0 , 3.7 , and 1.5 mm , and in males 13.8 , 11.7 , and 10.3 mm , respectively ) . Mainly , women reported hoarseness ( 9 females ) and cervical discomfort ( 7 females , 3 males ) 1 month postoperatively . After 6 months , these complaints resolved ( cervical discomfort 1 female ) . Conclusion Laryngeal mobility was significantly impaired postoperatively and only females revealed a recovery close to baseline after 6 months . Although showing only a small grade of recovery of laryngeal movement , subjective clinical symptoms were found to be rare in male patients BACKGROUND We performed a prospect i ve analysis on voice and swallowing alterations following  total thyroidectomy ( TT )  , in the absence of recurrent nerve injury . METHODS Patients aged 21 to 65 years undergoing TT , in the absence of laryngeal/pulmonary disease , previous neck surgery , or malignant diseases , were subjected to videostrobolaryngoscopy ( VSL ) , acoustic voice analysis ( AVA ) , and maximum phonation time ( MPT ) tests preoperatively and 3 months postoperatively . Voice impairment scores ( VIS ) and swallowing impairment scores ( SIS ) were obtained preoperatively , and at 1 week , 1 month , and 3 months postoperatively . RESULTS Among the 127 selected patients , 39 completed the postoperative evaluation . No recurrent nerve injury was observed during the postoperative VSL in any of the patients . Preoperative and postoperative AVA and MPT scores did not differ significantly . The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT ( 13.7 and 9.6 vs 4.4 , respectively ; P < .05 ) but not 3 months after TT ( 6.7 ) . The mean SIS was higher than the preoperative SIS at 1 week , 1 month , and 3 months after TT ( 10.3 , 6.0 , and 2.8 vs 0.5 , respectively ; P < .05 ) . CONCLUSIONS Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy , and our data suggest mild symptoms may occur in the majority of operated patients BACKGROUND Patients undergoing thyroidectomy  often complain aerodigestive disorders . In a previous study we showed the associations between voice impairment and proximal acid reflux , swallowing impairment and Upper Esophageal Sphyncter ( UES ) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy . This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18 - 24 months . PATIENTS AND METHODS The thirty-six patients prospect ively recruited according to selection criteria ( thyroid volume ≤60 ml , benign disease , age 18 - 65 years , previous neck surgery , thyroiditis , pre- or postoperative vocal cord palsy )  underwent voice ( VIS ) and swallowing ( SIS ) impairment scores , esophageal manometry and pH monitoring once again . RESULTS After 18 - 24 months , both VIS and SIS recovered ( respectively : p=0,022 ; p=0,0001 ) ; UES pressure increased ( p=0,0001 ) nearing the preoperative values . The persistence of swallowing complaints were associated with the persistence of esophageal incoordination ( p=0,03 ) ; the association between voice impairment and proximal acid reflux was confirmed ( p<0,001 ) . CONCLUSIONS Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy , largely transient , are strictly connected with upper esophageal motility changes . In this viewpoint , the innervation of upper aerodigestive anatomical structures ( larynx , pharynx , upper esophagus ) and its variations should be focused Objective Swallowing and voice impairment are common after thyroidectomy . We evaluated short-term functional changes in esophageal motility in a series of patients who had undergone total thyroidectomy .  Several studies have investigated these symptoms by means of interviews or question naires . Study Design Prospect i ve study . Setting Academic research . Material s and Methods Thirty-six consenting patients were prospect ively recruited . Eligibility criteria were thyroid volume ≤60 mL , benign disease , and age between 18 and 65 years . Exclusion criteria were previous neck surgery , severe thyroiditis , hyperthyroidism , and pre- or postoperative vocal cord palsy . Voice impairment score , swallowing impairment score , lower esophageal sphincter pressure , esophageal motility , upper esophageal pressure , and coordination were evaluated preoperatively and 30 to 45 days after surgery . Results Postoperative swallowing impairment ( appearance or worsening of dysphagia ) was found in 20 % of patients and voice impairment in more than 30 % . Both preoperative and postoperative esophageal motility were similar . All patients showed an average decrease of 25 % in upper esophageal pressure , although the pressure was within normal range . Swallowing alterations were associated with upper esophageal incoordination ( P < .03 ) , and proximal acid reflux was significantly associated with voice impairment ( P < .02 ) . Conclusion After uncomplicated thyroidectomy , decreased upper esophageal pressure may explain both pharyngeal ( dysphagia ) and laryngeal ( vocal impairment ) exposure to acid . In the future , proton pump inhibitor therapy protocol s should be evaluated A globus sensation is one of the most common complaints in otolaryngologic clinics , and laryngopharyngeal reflux is the most common cause . However , thyroid nodules also can cause globus symptoms . The purpose of this study was to identify 
    Output:
    
The prevalence increased with goiter size and with the extent of substernal extension .
Esophageal physiology changes :  Goiter patients had increased esophageal transit time , positively correlated with goiter size , but unrelated to esophageal motility disturbances .
Decrease in the upper esophageal sphincter pressure occurred early after surgery , and normalized within 6 months .
Swallowing related patient-reported outcomes : Evaluated by vali date d question naires , swallowing symptoms worsened in the early period after thyroidectomy , but improved after 6 months , as compared to baseline .
Conclusions : Thyroidectomy relieved patients with goiter from dysphagia , within 6 months of surgery probably via increase in the cross-sectional area of the esophagus .