Increasingly, researchers casually use the concept of coming out. After tracing its conceptual inflation, this article shifts the lens from identity development to reconsider coming out as identity management. I develop the perspective of strategic outness – the contextual and continual management of identity – to emphasize the role of social context in sexual identity disclosure. Using data from open-ended essays, I explore three aspects of strategic outness: strategies, motivational discourses, and social relationships. My participants discuss using multiple strategies to manage who knows about their sexuality, cohesively describe multiple motivations for controlling that information, and emphasize the role of social relationships in their decision-making. Strategic outness reconsiders how coming out is used with sexuality research, providing researchers with an explicit perspective to consider the social context of sexual identity disclosure in their analyses.

Patients with papillary thyroid cancer commonly confront the perception that their malignancy is "good," but the favorable prognosis and treatability of the disease do not comprehensively represent their cancer fight. The "good cancer" perception is at the root of many mixed and confusing emotions. Clinicians emphasize optimistic outcomes, hoping to comfort, but they might inadvertently invalidate the impact thyroid cancer has on patients' lives.

Importance Voice changes after thyroidectomy are typically attributed to recurrent laryngeal nerve injury. However, most postoperative voice changes occur in the absence of clinically evident vocal fold paralysis. To date, no study has compared the prevalence, duration, and consequences of voice-related disability from the patient perspective with use of quantitative vocal measures. Objective To assess quality of life consequences of posthyroidectomy voice change from the perspective of patients with thyroid cancer and to compare patient-perceived voice changes with changes in quantitative vocal variables at 5 time-points in the first postoperative year. Design Prospective Mixed-methods Observational Study within a Randomized Clinical Trial (NCT02138214) Setting University of Wisconsin Hospital and Clinics Participants Forty-two patients with clinically node-negative papillary thyroid cancer without a pre-existing vocal cord paralysis were recruited and enrolled from outpatient clinics between June 6, 2014 and March 6, 2017 as part of an ongoing randomized clinical trial. Interventions Total thyroidectomy Main Outcome(s) and Measure(s) Semi-structured interviews, symptom prevalence, and instrumental voice evaluations (Laryngoscopy, Phonation Threshold Pressure, Dysphonia Severity Index, Voice Handicap Index) occurred at baseline (n=42), 2-week (n=42), 6-week (n=39), 6-month (n=35), and 1-year (n=30) postoperative time points. Results Participants had a mean age of 48 years (interquartile range, 38–58 years; age range, 22–70 years) and were mostly female (74% [31 of 42]) and of white race/ethnicity (98% [41 of 42]). Impaired communication was the primary theme derived from patient interviews from before thyroidectomy to after hyroidectomy. Voice changes were perceived by 24 participants at 2 weeks after thyroidectomy. After surgery, voice symptoms were prevalent and persisted for 50% (21 of 42) of participants out to at least 1-year of follow-up. Quantitative vocal perturbations were detected in Dysphonia Severity Index and Voice Handicap Index at the 2-week follow-up, but returned to baseline levels by the 6-week follow-up visit. Conclusions and Relevance Voice changes are common after surgery for papillary thyroid cancer and affect quality of life for many patients out to 1-year of follow-up. Directly querying patients about postoperative voice changes and questioning whether commonly-used aerodynamic and acoustic parameters detect meaningful voice are important in identifying patients whose quality of life has been affected by post-thyroidectomy dysphonia. Trial Registration NCT02138214; https://clinicaltrials.gov/ct2/show/NCT02138214