During thyroidectomy, which nerve is at risk due to its course in the tracheoesophageal groove?

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During thyroidectomy, the key idea is that the recurrent laryngeal nerve runs in the tracheoesophageal groove and ascends to the larynx to supply most of the intrinsic muscles that move the vocal cords. This anatomical path places the nerve right in the area where the thyroid is mobilized and where the inferior thyroid vessels are ligated, making it highly susceptible to injury. If the nerve is damaged on one side, vocal cord paralysis causes hoarseness; if both sides are injured, there can be more serious airway issues. The other nerves listed don’t follow this groove in the neck: the hypoglossal nerve innervates the tongue, the glossopharyngeal nerve has functions in the oropharynx, and while the vagus nerve gives rise to the recurrent laryngeal nerve, it’s the recurrent branch itself that travels in this groove and is at risk during thyroid dissection.