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The most important and serious complication of thyroid surgery is recurrent laryngeal nerve (RLN) injury, and it has been noted that this risk increases considerably in the presence of anatomical variations. Double recurrent laryngeal nerve (DRLN) is very rare among RLN anatomical variations. There are only a few case reports on DRLN in the literature It is crucial to possess surgical expertise and ensure complete visualization of the nerve to minimize the likelihood of RLN injury. Intraoperative nerve monitoring (IONM) is particularly useful in identifying anatomical variations. In a 54-year-old woman undergoing diagnostic left lobectomy+isthmectomy, a left DRLN was identified during intraoperative exploration and meticulous nerve exploration with the assistance of IONM monitoring verified that the impulse conduction in both branches was identical. The surgical procedure was successfully performed without causing any harm to the nerve. Based on the case reports in the literature and our experience with this patient, we believe that surgical expertise and the utilization of IONM can decrease RLN nerve damage and reveal its anatomical variations during thyroid surgery.

The thyroid gland is an endocrine organ comprising two lobes connected by an isthmus. Thyroid isthmus agenesia (TIA) is a rare anatomical anomaly, which has only been documented in a limited number of case reports. This report presents the case of a 49-year-old female patient who was diagnosed with intraoperative TIA during diagnostic thyroid lobectomy. The patient was arranged for a diagnostic lobectomy of the right thyroid lobe after identifying an atypical nodule of undetermined significance, in the right lobe, which had been confirmed with two distinct biopsies. The patient was discovered to have isthmus agenesia during a neck exploration performed under general anesthesia. Owing to its rarity, the precise clinical and anatomical characteristics of TIA have not been defined, and its underlying cause is still not completely understood. The detection of TIA warrants the considerations of any other accompanying diseases. Prior identification and assessment of surgical approach are crucial for ensuring a secure surgical procedure and mitigating the risk of surgical complications. Nevertheless, caution must be exercised if TIA is detected during operation because preoperative identification is not always feasible. In summation, additional patient reports and studies are required to uncover the underlying cause of this pathological condition.