Thyroidectomy: post-operative complications and management

Authors

  • Nikhil Soni Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
  • Bapuji Shravan Gedam Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
  • Murtaza Akhtar Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191887

Keywords:

Thyroid swellings, Thyroidectomy, Post-operative complications, Hypocalcemia, RLN palsy

Abstract

Background: Thyroidectomy is a surgical procedure indicated as elective treatment for symptomatic thyroid swellings or neoplasms. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Hence, before any thyroid surgery patient must be precisely informed the possible complications and their remedies. The present study aims to evaluate post-operative complications after thyroid surgery.

Methods: In a tertiary care hospital based longitudinal study patients presenting with clinically and sonographically diagnosed thyroid swelling who underwent surgical intervention were enrolled in the study. These patients were evaluated for thyroid profile test, fine needle aspiration cytology (FNAC), pre-operative and post-operative indirect laryngoscopy, serum calcium level and histopathology. Intra operative and post-operative assessment was done for bleeding, hematoma, and surgical site infection.

Results: A total of 53 patients were enrolled. Thyroid swelling was more common in females (F: M =5.6:1) mostly presenting in 3rd and 4th decades with mean age of 38.1 years. Hemithyroidectomy was the most common procedure performed (63.6%) followed by total (27.3%) and near total thyroidectomies (5.5%). On histopathological examination most common finding was nodular goiter (49.1%) followed by multinodular goiter (28.3%), follicular adenoma (16.9%) and malignancies (5.7%). The post-operative complications after thyroidectomies were hypocalcemia (16.9%), recurrent laryngeal nerve (RLN) injury (5.7%), and surgical site infection (1.9%).

Conclusions: Careful evaluation of post thyroidectomy complications will help in reducing these complications and patient’s safety.

Author Biographies

Nikhil Soni, Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Junior Resident,

Dept of Surgery

Bapuji Shravan Gedam, Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Professor,

Dept of Surgery

Murtaza Akhtar, Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Professor & Head,

Dept of Surgery

References

Ravikumar S, Vasantha WE. A Study of Incidence of Complications In Thyroid Surgery. Indian J Applied Res. 2018;8(9).

Bhattacharyya N, Fried MP. Assessment Of The Morbidity And Complications Of Total Thyroidectomy. Arch Otolaryngol–Head Neck Surg. 2002;128(4):389-92.

Richmond BK, Eads K, Flaherty S, Belcher M, Runyon D. Complications Of Thyroidectomy And Parathyroidectomy In The Rural Community Hospital Setting. Am Surgeon. 2007;73(4):332-6.

Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications To Thyroid Surg: Results As Reported In A Database From A Multicenter Audit Comprising 3,660 Patients. Langenbeck's Arch Surg. 2008;393(5):667-73.

Leigh D, Ana I, Tom SR. Total Thyroidectomy For Bilateral Benign Multinodular Goiter. Arch. Surg. 1999;134:1389-93.

Davies TF, Larsen PR. Thyrotoxicosis. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, Editors. Williams Textbook of Endocrinology. Saunders; 2002: 374-422.

Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism After Total Thyroidectomy: A Prospective Study. Arch Surg. 2008;143(2):132-7.

Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of The Complications Of Subtotal, Near Total And Total Thyroidectomy In The Surgical Management Of Multinodular Goitre. Endocrine J. 2005;52(2):199-205.

Filho JG, Kowalski LP. Surgical Complications After Thyroid Surg Performed In A Cancer Hospital. Otolaryngol Head Neck Surg. 2005;132(3):490-4.

Karamanakos SN, Markou KB, Panagopoulos K, Karavias D, Vagianos CE, Scopa CD, et al. Complications And Risk Factors Related To The Extent Of Surgery In Thyroidectomy. Results From 2,043 Procedures. Hormones (Athens). 2010;9(4):318-25.

Dinc T, Kayilioglu SI, Simsek B, Guldogan CE, Gulseren MO, Saylam B, et al. The Evaluation Of The Complications Observed In Patients With Bilateral Total And Bilateral Near Total Thyroidectomy. Annali Italiani Di Chirurgia. 2017;88:198-201.

Jamski J, Jamska A, Graca M, Barczyński M, Włodyka J. Recurrent Laryngeal Nerve Injury Following Thyroid Surg. Przeglad Lekarski. 2004;61(1):13-6.

Erbil Y, Barbaros U, Işsever H, Borucu I, Salmaslıoğlu A, Mete Ö, et al. Predictive Factors For Recurrent Laryngeal Nerve Palsy And Hypoparathyroidism After Thyroid Surg. Clin Otolaryngol. 2007;32(1):32-7.

Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, et al. Postoperative Complications Of Thyroid Surg: A Corroborative Study With An Overview Of Evolution Of Thyroid Surg. Int J Head Neck Surg. 2015;6(4):149-54.

Joliat GR, Guarnero V, Demartines N, Schweizer V, Matter M. Recurrent Laryngeal Nerve Injury After Thyroid And Parathyroid Surgery: Incidence And Postoperative Evolution Assessment. Medicine. 2017;96(17):1.

Dionigi G, Rovera F, Boni L, Castano P, Dionigi R. Surgical Site Infections After Thyroidectomy. Surgical Infections. 2006;7(Suppl 2):S-117.

Anbalagan P, Manikannan AS, Khan AM, Imran M. Study Of Post-Operative Complications Of Thyroid Surg. J Evol Med Dent Sci. 2017;6(5):413-8.

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Published

2019-04-29

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Section

Original Research Articles