LAUSR

Editor Thanks to Piccin et al. for their comment on our article on avoiding staged thyroidectomy in cases of initial signal loss1. The authors, however, do not discuss our data or our reasoning, they merely give their opinion. I would have preferred a scientific discussion since this is what it is all about. Our understanding is that our data, the first ever published on the clinical outcome of initial signal loss, support our approach. The authors ‘strongly’ advise postponing contralateral surgery, but this is based only on a respectable opinion. No hard data have ever been presented on the benefits of such an approach. Guidelines, no matter what they deal with, are fine to summarize the state of the art, but their scientific value is controversial2. They may, in fact, prevent critical thinking and delay, or even block, the burgeoning of new ideas. Piccin et al. insist on the old principle that prevention of bilateral recurrent laryngeal nerve (RLN) palsy, ‘should be considered the main reason to utilize nerve stimulation’. This is no longer the case, if it were, neuromonitoring would be used to prevent a complication that develops in one to three cases per 1000 patients. It would be pretty inefficient! Neuromonitoring is here to stay for many reasons other than RLN palsies: it has an almost 100 per cent positive predictive value for appropriate postoperative nerve function and is very helpful in the differential diagnosis