ABSTRACT Objective: To construct a prediction model of vocal cord paralysis in patients undergoing thyroid cancer surgery for the first time, and to predict the incidence of vocal cord paralysis. Methods:The clinical data of 394 patients with thyroid cancer in our hospital from January 2012 to February 2022 were collected retrospectively. According to the postoperative silent zone paralysis, they were divided into vocal cord paralysis group and silent zone paralysis group. According to the time sequence, 358 patients from January 2012 to may 2021 were used as the modeling group and 36 patients from June 2021 to February 2022 were used as the validation group. The basic data of clinical patients in the two groups were collected and analyzed by univariate and multivariate analysis, The most appropriate independent variables were selected to construct a logistic regression model to analyze the influencing factors of vocal cord paralysis after thyroid cancer surgery. The internal was verified by ten fold cross validation, and the external validation was verified by comparing the differentiation, calibration and clinical effectiveness of the modeling group and the validation group. The receiver operating characteristic (ROC) curve, calibration curve and clinical decision-making curve were drawn to evaluate the predictive value of the logistic regression model, and the Jordan index, sensitivity, specificity Predict the probability p value, calculate the Y value according to p = 1 / 1 + e-y, and finally draw the nomogram diagram. Results: All 394 patients completed surgical resection of thyroid cancer at one time. 41 patients developed vocal cord paralysis after operation. The incidence of vocal cord paralysis was 10.4%. Logistic regression model showed that whether the recurrent laryngeal nerve entered the larynx (OR = 11.804, 95% CI 3.078 ~ 45.273), preoperative TG (OR = 0.021, 95% CI 0.002 ~ 0.202), whether it was close to the recurrent laryngeal nerve (OR = 20.984, 95% CI 2.058 ~ 214.007), and operation time (OR = 2.768, 95% CI 1.122 ~ 6.829) were independent predictors of vocal cord paralysis after thyroid cancer surgery. Ten fold cross validation showed that the area under the ROC curve was 0.7284, the area under the ROC curve in the modeling group was 0.7943 (95% confidence interval was 0.716 ~ 0.872), and the area under the ROC curve in the validation group was 0.7722 (95% confidence interval was 0.526 ~ 1); Hosmer lemeshow goodness of fit test showed that the model fitted well, chi square = 1.1, p = 0.9816 > 0.05 in the modeling group and chi square = 3.87, p = 0.5677 > 0.05 in the validation group; The maximum youden's?index is 0.188, the sensitivity is 0.57, the specificity is 0.62, the area under the ROC curve is 0.59,p = 0.216, which is the best critical value. According to p = 1 / 1 + e-y, y = -1.25. Conclusion: The prediction accuracy of this regression model is good, and it has a certain reference significance for the occurrence of vocal cord paralysis after thyroid cancer surgery.