This syndrome is characterized by sensorineural hearing loss, which may be present at birth or develop during childhood. It may also be accompanied by an enlargement of the thyroid gland (goiter) due to a defect in thyroid hormone synthesis, without necessarily causing impaired thyroid function. The clinical manifestations and severity of Pendred syndrome vary from one patient to another, making early diagnosis and thorough evaluation essential for determining the most appropriate treatment plan. Although no definitive cure for the underlying genetic defect is currently available, advances in diagnostic techniques and auditory rehabilitation, including cochlear implantation in suitable cases, have improved communication outcomes and quality of life for affected individuals. Accordingly, this article on My Medical Guide aims to shed light on Pendred syndrome by discussing its causes, symptoms, and diagnostic methods, while reviewing available treatment options and emphasizing the importance of ongoing medical follow-up.

1. 1. What is Pendred syndrome?

   Pendred syndrome is a genetic disorder associated with sensorineural hearing loss, which may be accompanied by an enlarged thyroid gland (goiter) and abnormalities of the inner ear in many affected individuals.

   2. Is Pendred syndrome a hereditary disease?

   Yes, Pendred syndrome is a hereditary disorder that is usually inherited in an autosomal recessive pattern. This means that a child inherits one altered copy of the disease-causing gene from each parent.

   3. Is Pendred syndrome contagious?

   No, Pendred syndrome is not contagious. It is a genetic disorder caused by changes in genes and cannot be transmitted from one person to another through physical contact or everyday interactions.

   4. Are the symptoms of Pendred syndrome present at birth?

   Hearing loss may be present at birth or develop during childhood, while thyroid enlargement may appear later in life, particularly during late childhood or adolescence.

   5. Can Pendred syndrome lead to complete deafness?

   Yes, hearing loss may progress to severe or profound levels in some individuals. However, the severity of hearing loss and the rate at which it progresses vary from person to person.

   6. Does Pendred syndrome affect one ear or both ears?

   Pendred syndrome usually affects both ears, although the degree of hearing loss may differ between them.

   7. Can hearing suddenly deteriorate in people with Pendred syndrome?

   Yes, hearing loss may worsen suddenly or gradually. Some affected individuals may also experience fluctuations in their hearing ability over time.

   8. Does Pendred syndrome cause dizziness and balance problems?

   Pendred syndrome may affect the balance system of the inner ear, potentially causing dizziness or balance disturbances. However, these symptoms do not occur in all affected individuals.

   9. Do all people with Pendred syndrome develop an enlarged thyroid gland?

   No, not all individuals with Pendred syndrome develop an enlarged thyroid gland. Goiter may appear later in life, while some individuals may never develop it. Thyroid function may also remain normal despite the presence of thyroid enlargement.

   Pendred Syndrome

   First: Types of Pendred Syndrome

   Two main clinical patterns can be distinguished within the spectrum of disorders associated with disease-causing variants in the SLC26A4 gene, depending on the clinical manifestations and the extent of thyroid involvement.

   1. Classic Pendred Syndrome

   This form is characterized by a combination of signs and symptoms, most notably:

   • Sensorineural hearing loss: Usually develops during childhood but may also be present at birth.

   • Inner ear abnormalities: One of the most prominent findings is an enlarged vestibular aqueduct (EVA).

   • Thyroid enlargement: Goiter may develop during late childhood or adolescence.

   • Potentially normal thyroid function: Thyroid hormone levels and overall thyroid function may remain within normal ranges despite the presence of an enlarged thyroid gland.

   2. SLC26A4-Related Hearing Loss Without Clear Thyroid Manifestations

   This pattern falls within the spectrum of disorders associated with the SLC26A4 gene and may be characterized by the following features:

   • Sensorineural hearing loss: Hearing loss of varying degrees of severity.

   • Possible inner ear abnormalities: These may include an enlarged vestibular aqueduct or other structural abnormalities of the inner ear.

   • Absence of noticeable thyroid enlargement: Goiter may be absent and may never develop throughout the individual's lifetime.

   • Association with DFNB4: This term refers to a form of hereditary hearing loss associated with the same gene, but it is not an exact synonym for classic Pendred syndrome.

   It is important to note that identifying the specific clinical pattern requires comprehensive clinical, audiological, and genetic evaluation. The absence of thyroid enlargement alone is not sufficient to rule out an SLC26A4-related disorder.

    

2. Causes of Pendred Syndrome

   1. Pathogenic Variants in the SLC26A4 Gene

   The primary cause of Pendred syndrome is the presence of disease-causing genetic variants in a gene called SLC26A4, located on chromosome 7 at cytogenetic region 7q22.3.

   This gene contains the instructions for producing a protein known as pendrin, an ion transporter that helps transport substances such as chloride, bicarbonate, and iodide in various tissues of the body, including the inner ear and thyroid gland.

   When genetic variants impair the function of this protein, two essential processes may be affected:

   • Inner ear development and fluid and ion balance: This may lead to structural abnormalities and impaired auditory function.

   • Iodide transport in the thyroid gland: This may affect the efficiency of thyroid hormone synthesis and contribute to thyroid enlargement in some affected individuals.

   Not all variants identified in the SLC26A4 gene necessarily cause the disease. Genetic test results must be interpreted according to the nature of the identified variants, their established effects on protein function, and the patient's clinical findings.

   How Do Genetic Variants Cause Pendred Syndrome?

   1. Effects on the Inner Ear and Hearing

   The inner ear contains the cochlea, the structure responsible for converting sound vibrations into nerve signals transmitted to the brain. It also contains other structures that play an essential role in maintaining balance.

   The normal function of these structures depends on maintaining the appropriate composition of inner ear fluids, ionic balance, and pH.

   When pendrin function is impaired by genetic variants, several disturbances may occur, including the following:

   A. Disruption of fluid and ion balance

   Impaired pendrin function may alter the chemical environment of the inner ear, affecting the conditions required for normal auditory function.

   B. Structural abnormalities of the inner ear

   Anatomical abnormalities may develop, most notably an enlarged vestibular aqueduct (EVA). Changes in the shape or development of the cochlea may also occur.

   C. Impaired auditory function

   Changes affecting the inner ear may interfere with normal hearing mechanisms, resulting in sensorineural hearing loss of varying severity.

   D. Changes in hearing over time

   Hearing loss may be present at birth or develop during the first years of life. It may progress gradually or fluctuate in some individuals, with episodes of sudden deterioration.

   Important note: An enlarged vestibular aqueduct is a common finding associated with hearing disorders caused by SLC26A4 variants. However, the precise relationship between this abnormality and hearing loss is not fully understood. Its presence alone is insufficient to confirm a diagnosis of Pendred syndrome.

   2. Effects on the Thyroid Gland

   The thyroid gland requires iodine to produce thyroxine (T4) and triiodothyronine (T3), two essential hormones involved in regulating metabolism and growth.

   Pendrin contributes to the transport of iodide across the apical membrane of thyroid follicular cells into the follicular lumen, where iodine is used in the hormone synthesis process.

   When pendrin function is impaired, several changes may occur:

   • Reduced iodide transport efficiency: The movement of iodide to the site required for thyroid hormone synthesis may be affected.

   • Disruption of hormone synthesis: The production of T3 and T4 may become less efficient, particularly when the thyroid gland's iodine requirements increase.

   • Increased thyroid stimulation: The gland may respond to this impairment through compensatory activity and tissue growth.

   • Development of goiter: Thyroid enlargement, medically known as goiter, may occur and can be accompanied by hypothyroidism in some affected individuals.

   Nevertheless, thyroid hormone levels may remain normal in many individuals, even when noticeable thyroid enlargement is present.

   Therefore, an enlarged thyroid gland does not necessarily indicate hypothyroidism, and normal thyroid function test results do not exclude Pendred syndrome.

   How Is Pendred Syndrome Inherited from Parents to Children?

   Pendred syndrome is usually inherited in an autosomal recessive pattern. This means that an affected individual typically has two disease-causing variants in the SLC26A4 gene, one inherited from the father and the other from the mother.

   When both parents carry one disease-causing variant in the same gene, each pregnancy generally has the following probabilities:

   • 25% probability: The child inherits both altered copies and is affected.

   • 50% probability: The child inherits one altered copy and is an unaffected carrier.

   • 25% probability: The child inherits neither altered copy and is not a carrier of either familial variant.

   These probabilities apply independently to each pregnancy.

   Are There Other Causes or Factors That Increase the Likelihood of Pendred Syndrome?

   It is important to distinguish the underlying genetic cause of Pendred syndrome from factors that may influence the severity of certain manifestations or their likelihood of appearing.

   1. Iodine Deficiency

   Iodine deficiency is not the primary cause of Pendred syndrome, which results from pathogenic variants in the SLC26A4 gene. However, iodine deficiency may contribute to an increased likelihood of thyroid enlargement in affected individuals.

   2. Consanguineous Marriage

   Consanguinity does not itself cause genetic mutations. However, it may increase the likelihood that both parents carry the same disease-causing variant, thereby increasing the risk of having a child affected by an autosomal recessive disorder.

   3. Environmental Factors

   There is insufficient evidence to identify any specific environmental factor as a direct cause of Pendred syndrome. Nevertheless, certain factors may influence the course or severity of hearing loss in some affected individuals without being the underlying genetic cause of the syndrome.

   4. Absence of a Family History

   The absence of known affected relatives does not rule out Pendred syndrome. Genetic variants may be passed through several generations without causing the disease in individuals who carry only one altered copy of the gene.

   Why Does the Severity of Pendred Syndrome Vary from Person to Person?

   The clinical manifestations of Pendred syndrome vary considerably, even among individuals with pathogenic variants in the same gene. This variability may be associated with the specific genetic variants involved and other biological factors that are not yet fully understood.

   The condition may present in several different ways, including:

   • An individual with severe hearing loss beginning in childhood but no noticeable thyroid enlargement.

   • An individual with progressive hearing loss accompanied by an enlarged vestibular aqueduct.

   • An individual with hearing loss and an enlarged thyroid gland but normal thyroid hormone levels.

   • An individual with SLC26A4-related hearing loss who does not develop the full clinical presentation of classic Pendred syndrome.

   This variability demonstrates that SLC26A4-related disorders form a clinical spectrum, ranging from isolated hearing loss to Pendred syndrome accompanied by thyroid manifestations.

   Symptoms of Pendred Syndrome

   The symptoms of Pendred syndrome vary from one individual to another in their nature, severity, and age of onset. Sensorineural hearing loss is the most prominent manifestation, and it may be accompanied by thyroid enlargement and balance disturbances in some affected individuals.

   What Are the Symptoms of Hearing Loss?

   Hearing loss is one of the most common features of Pendred syndrome. Its main manifestations include the following:

   • Sensorineural hearing loss: This may be present at birth or develop during the first years of life as a result of abnormalities affecting the inner ear, which is responsible for detecting sounds and converting them into nerve signals.

   • Variable severity of hearing loss: Hearing loss may range from mild to moderate or severe and may progress to profound hearing loss.

   • Changes in hearing over time: Hearing loss may worsen gradually or occur in episodes. Some individuals may experience fluctuations in their hearing ability.

   • Difficulty understanding speech: Affected individuals may struggle to distinguish words and understand conversations, particularly in crowded places or noisy environments.

   • Delayed speech and language development in children: Hearing loss during early childhood may delay language acquisition and speech development, especially when the condition is not identified early and the child does not receive appropriate hearing and language support.

   • Differences in hearing loss between the ears: Hearing loss may be asymmetric, meaning that one ear is affected more severely than the other.

   Some individuals may experience a deterioration in hearing following minor head trauma. However, this does not occur in everyone, and not every head injury necessarily results in worsening hearing ability.

    

3. Thyroid Symptoms Associated with Pendred Syndrome

   Thyroid-related changes may develop during late childhood, adolescence, or adulthood. The most prominent manifestations include:

   • Thyroid enlargement (goiter): An increase in the size of the thyroid gland, which may appear as swelling in the front of the neck.

   • A feeling of pressure or fullness in the neck: Some individuals may experience discomfort due to an enlarged thyroid gland.

   • Difficulty swallowing or breathing: These symptoms may occur when significant thyroid enlargement compresses nearby tissues or organs.

   • Hypothyroidism: Some affected individuals may develop an underactive thyroid due to impaired thyroid hormone synthesis, although this does not occur in every patient.

   It is important to note that many individuals with Pendred syndrome maintain normal thyroid hormone levels despite having an enlarged thyroid gland. Consequently, noticeable thyroid-related symptoms may be absent even when the syndrome is present.

   Symptoms of Balance Disorders

   Some individuals with Pendred syndrome may experience balance disturbances due to the involvement of inner ear structures responsible for maintaining balance. Symptoms may include:

   • Unsteadiness while walking.

   • Uncoordinated movements or frequent stumbling and falls.

   • Delayed acquisition of walking skills in some children.

   • Dizziness or a sensation of imbalance.

   • Nausea or vomiting in some cases involving vestibular dysfunction.

   However, not all individuals with Pendred syndrome experience noticeable balance problems. Vestibular function may remain normal, or symptoms may be mild in some patients.

   Does Pendred Syndrome Cause Speech Delay or Intellectual Disability?

   1. Speech and Language Delay

   Hearing loss that begins early in life may lead to delayed speech and language development because a child may not hear sounds and words adequately to acquire spoken language.

   Early diagnosis and appropriate auditory and language intervention are therefore essential to support the development of communication skills.

   2. Intellectual Disability

   Intellectual disability is not a typical feature of Pendred syndrome itself. Hearing loss does not necessarily indicate impaired intellectual ability or intelligence, and children with the condition may have normal cognitive development despite experiencing hearing difficulties.

   3. Physical Growth

   Physical growth is generally normal in affected individuals, particularly when thyroid function remains normal. However, untreated hypothyroidism may affect growth and development, making appropriate medical monitoring essential.

   Treatment of Pendred Syndrome: Medications and Available Treatment Options

   Treatment for Pendred syndrome depends on the patient's symptoms, the severity of hearing loss, thyroid function, and the presence of balance disorders.

   Because Pendred syndrome is a genetic disorder usually associated with variants in the SLC26A4 gene, there is currently no established medication that eliminates the underlying genetic cause or reliably restores lost hearing. Treatment therefore focuses on managing symptoms, preserving remaining function, and improving quality of life.

   First: Medications and Treatment Options According to the Health Problem

   1. Treatment of Hearing Loss

   A. Hearing Aids

   Hearing aids are not medications, but they are among the most important treatment options for individuals with Pendred syndrome. Their type and suitability are determined according to the degree of hearing loss and the results of audiological assessments.

   These devices can improve the ability to hear speech and communicate, particularly in children who require early support for speech and language development.

   B. Corticosteroids

   Corticosteroids are not routinely used to treat chronic hearing loss associated with Pendred syndrome, and there is insufficient evidence that they prevent long-term genetic hearing deterioration.

   However, if sudden hearing loss occurs, the patient should seek urgent assessment by an ear, nose, and throat (ENT) specialist, preferably on the same day. Depending on the clinical assessment and the timing of symptom onset, the physician may recommend oral corticosteroids or corticosteroid injections into the middle ear.

   Corticosteroids should not be taken without medical supervision. Their use depends on the cause and duration of hearing loss, the patient's overall health, and any potential contraindications.

   C. Other Medications for Hearing Loss

   No medication has yet been established as an effective treatment for restoring hearing lost as a result of Pendred syndrome.

   Antibiotics, antivirals, and medications marketed to improve blood circulation are not recommended as routine treatments for the syndrome unless another medical condition specifically warrants their use.

   If hearing loss is severe or profound and conventional hearing aids provide insufficient benefit, the patient may be evaluated for a cochlear implant.

   2. Treatment of Thyroid Enlargement (Goiter)

   Thyroid enlargement may occur in individuals with Pendred syndrome, particularly as they grow older. However, the presence of goiter does not necessarily indicate inadequate thyroid hormone production.

   Treatment therefore depends on thyroid function test results and other clinical findings, rather than thyroid enlargement alone.

   A. Levothyroxine

   Levothyroxine is a synthetic thyroid hormone equivalent to thyroxine (T4). It is used to replace deficient thyroid hormones in individuals with hypothyroidism.

   • Indications: It is prescribed when hypothyroidism is confirmed through medical evaluation and laboratory testing, not simply because Pendred syndrome or thyroid enlargement is present.

   • Dosage determination: The physician determines the dose based on age, weight, thyroid-stimulating hormone (TSH) levels, free T4 levels, and the patient's overall health.

   • Administration: It is usually taken on an empty stomach, approximately 30–60 minutes before breakfast, or according to the physician's instructions.

   • Monitoring: Thyroid function tests are commonly repeated approximately 6–8 weeks after starting treatment or adjusting the dose, depending on the treatment plan.

   Levothyroxine is not routinely recommended to shrink an enlarged thyroid when thyroid function is normal, unless a specific medical indication exists. Excessive doses may cause palpitations, abnormal heart rhythms, and an increased risk of bone loss.

   B. Iodine

   The body requires iodine to produce thyroid hormones. Pendred syndrome involves impaired iodide transport and handling within the thyroid gland because of dysfunction of the protein associated with the disease-causing gene.

   The following precautions are therefore important:

   • Obtain adequate dietary iodine according to local nutritional recommendations.

   • Avoid taking high doses of iodine or seaweed supplements to treat thyroid enlargement, as these may disrupt thyroid function.

   • Do not use therapeutic-dose iodine supplements unless there is a clear medical indication and a physician recommends them.

   3. Treatment of Thyroid Enlargement When Thyroid Function Is Normal

   If TSH and free T4 levels are normal and the enlarged thyroid causes no significant discomfort or compression of nearby structures, regular medical monitoring may be sufficient without medication.

   However, if the goiter is large, progressively enlarging, or causing difficulty swallowing or breathing, evaluation by an endocrinologist is recommended.

   Further assessment may include thyroid ultrasound, additional investigations, or surgery in selected cases, particularly when the enlarged gland compresses the trachea or esophagus or when another medical indication for intervention exists.

   4. Treatment of Dizziness and Balance Disorders

   Pendred syndrome may affect the inner ear, resulting in balance disturbances or difficulty walking in some patients.

   Treatment depends on the nature and cause of the symptoms and may include the following:

   A. Vestibular Rehabilitation

   Vestibular rehabilitation consists of exercises prescribed by a physical therapist or vestibular rehabilitation specialist to improve balance, postural stability, and walking ability while reducing the risk of falls.

   B. Medications for Vertigo

   A physician may prescribe medication to relieve acute episodes of vertigo or treat a specific underlying cause when necessary. However, these medications do not correct the genetic defect responsible for Pendred syndrome.

   Long-term use of vestibular suppressant medications without medical review is not recommended. Some of these drugs may cause drowsiness and, in certain cases, delay the nervous system's adaptation to balance disturbances.

   New or severe dizziness requires prompt medical evaluation, particularly when accompanied by sudden hearing changes or neurological symptoms.

   Second: Medications and Treatments Not Recommended for Routine Use

   Medication or treatment	Medical recommendation
   Long-term corticosteroids	Not routinely used to prevent progression of genetic hearing loss. They may be considered in specific situations, such as sudden hearing loss, following medical assessment.
   Levothyroxine with normal thyroid function	Not automatically prescribed to treat Pendred syndrome or shrink the thyroid gland.
   High-dose iodine	Self-treatment is not recommended because excessive iodine may disrupt thyroid function.
   Dietary supplements and antioxidants	Insufficient evidence supports their ability to correct the genetic cause or restore lost hearing.
   Antibiotics and antivirals	Not used to treat Pendred syndrome itself; they are reserved for infections that require specific treatment.
   Long-term vertigo medications	Should not be used without medical supervision because some may cause drowsiness or delay balance compensation.

   Third: Regular Medical Follow-Up

   Regular monitoring is an essential part of caring for individuals with Pendred syndrome, even when severe symptoms are absent.

   1. Hearing Monitoring

   • Perform regular hearing tests to determine the degree of hearing loss and monitor changes over time.

   • Young children may require more frequent assessments, such as every 3–6 months until three years of age, followed by annual assessments in many cases. The schedule should be individualized according to clinical findings and medical recommendations.

   • Reassess the need for hearing aids or cochlear implantation if hearing deteriorates or existing devices provide insufficient benefit.

   2. Thyroid Monitoring

   • Perform TSH and free T4 testing according to symptoms and previous results.

   • Assess thyroid size clinically and use ultrasound when indicated.

   • Do not assume that hypothyroidism is present simply because the thyroid gland is enlarged.

   3. Speech and Communication Monitoring in Children

   • Begin speech and language therapy early when hearing impairment affects communication development.

   • Provide appropriate hearing aids and evaluate cochlear implantation when necessary.

   • Monitor language development, communication skills, and educational progress.

   4. Prevention of Ear and Head Injuries

   • Minimize the risk of head injuries and use appropriate protective equipment during sports and other activities.

   • Discuss the risks of activities involving substantial pressure changes with an ENT specialist, particularly in patients with inner ear abnormalities.

   Surgical Treatment of Pendred Syndrome

   Some individuals with Pendred syndrome may require surgery. The two main surgical procedures that may be considered are cochlear implantation and thyroidectomy.

   The appropriate procedure depends on the patient's symptoms, degree of hearing impairment, thyroid size, and medical evaluation findings.

   First: Surgical Procedures Used in Pendred Syndrome

   1. Cochlear Implantation

   Cochlear implantation may be performed in patients with severe or profound sensorineural hearing loss who receive insufficient benefit from conventional hearing aids.

   Purpose of the procedure: To improve sound perception and speech understanding by converting sound signals into electrical signals that stimulate the auditory nerve.

   2. Thyroidectomy

   Thyroidectomy may be performed in selected cases, such as when severe thyroid enlargement compresses the trachea, causes difficulty swallowing, or when thyroid cancer is suspected or another medical indication for surgery exists.

   Purpose of the procedure: To remove part or all of the thyroid gland, depending on the patient's condition and the reason for surgery. This procedure does not treat the underlying genetic cause of Pendred syndrome; rather, it addresses thyroid-related complications.

   Second: How Is Cochlear Implant Surgery Performed?

   Cochlear implantation involves several essential stages.

   1. Preoperative assessment: Comprehensive hearing tests are performed to determine the degree of hearing loss and assess the benefit obtained from hearing aids. Computed tomography (CT) and magnetic resonance imaging (MRI) of the inner ear may also be performed when indicated.

   2. Anesthesia: The procedure is usually performed under general anesthesia.

   3. Access to the inner ear: The surgeon makes an incision behind the ear, accesses the mastoid bone, and prepares the surgical route to the cochlea.

   4. Electrode insertion: An electrode array is inserted into the cochlea according to the anatomy of the inner ear, while minimizing injury to surrounding tissues and structures.

   5. Placement of the internal device: The internal component of the cochlear implant is secured beneath the skin behind the ear in the appropriate position.

   6. Wound closure: The incision is closed, and the patient is monitored during recovery for potential complications.

   7. Device activation and auditory rehabilitation: After the wound has healed, the device is activated and the external component is programmed. The patient then begins an auditory and language rehabilitation program tailored to their needs.

   What Makes Cochlear Implantation Different in Patients with Pendred Syndrome?

   Pendred syndrome may be associated with inner ear abnormalities, including an enlarged vestibular aqueduct and structural changes in the cochlea. These anatomical differences may influence the surgical approach and require additional precautions.

   Potential risks include:

   • Cerebrospinal fluid leakage: This may occur during electrode insertion into the cochlea. A substantial flow of fluid during surgery is sometimes referred to as a CSF gusher.

   • Dizziness and balance disturbances: These may occur after surgery and can be temporary in some cases.

   • Other surgical complications: These include infection or injury to surrounding anatomical structures, which are potential risks of cochlear implantation in general.

   Despite these challenges, published studies indicate that cochlear implantation can significantly improve hearing outcomes in many appropriately selected patients. Major complications have not been common in most published reports.

   Important note: An enlarged vestibular aqueduct, by itself, is not an indication for surgery to close it. Furthermore, cochlear implantation does not restore natural hearing. Instead, it can improve sound perception and speech understanding to varying degrees, depending on the patient's condition and rehabilitation outcomes.

   Third: How Is Thyroidectomy Performed?

   The decision to perform thyroidectomy is made in collaboration between an endocrinologist and a thyroid surgeon, based on clinical symptoms and investigation results.

   The main stages of the procedure include the following:

   1. Preoperative investigations: Thyroid ultrasound is performed, and hormone levels such as TSH and free T4 are measured. Additional tests may be requested depending on the nature and size of the enlargement and the medical assessment.

   2. Anesthesia: The procedure is usually performed under general anesthesia.

   3. Surgical incision: The surgeon makes an incision in the lower front of the neck to access the thyroid gland.

   4. Identification and protection of important anatomical structures: The surgeon identifies and protects the recurrent laryngeal nerve, which controls vocal cord movement, and preserves the parathyroid glands, which play an essential role in regulating blood calcium levels.

   5. Removal of the required tissue: Part of the thyroid gland or the entire gland is removed, depending on the reason for surgery, the extent of enlargement, the patient's condition, and the investigation results.

   6. Wound closure and postoperative monitoring: The incision is closed, and the patient is monitored after surgery. Blood calcium levels, voice function, and breathing may be assessed as clinically indicated.