Arch Surg. 1932;24(3):426-439. doi:10.1001/archsurg.1932.01160150089003.
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The most successful operations on the goitrous or toxic thyroid comprise the preservation of parathyroid, laryngeal and tracheal function and the removal of enough glandular tissue to allow thyroid function to be controlled by the patient's physiologic reactions or by the administration of desiccated thyroid extract. The accidental injuries to the recurrent laryngeal nerves and parathyroid have encouraged most of the attention of surgeons to the middle and lower portions of the gland.

From observations of my own series of over 1,800 resections of all types of goiters and of many more operated on by other surgeons, I have witnessed an undesirably high percentage of changes in the tone of the voice, i. e., a lower pitch with a decreased range and huskiness, with or without a partial loss and lasting for a varying length of time. Changes in the voice and moderate obstructions to inspiration are generally of short


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