Postoperative complications after total thyroidectomy for benign thyroid diseases


  • Mohammed Nazeeh Shaker Nassar Department of Surgery, Menoufia Faculty of Medicine, Menoufia University Hospitals, Menoufia, Egypt
  • Ahmed Sabry Algammal Department of Surgery, Menoufia Faculty of Medicine, Menoufia University Hospitals, Menoufia, Egypt



ATD, Hashimoto’s thyroiditis, Graves’ disease, Thyroidectomy, Vocal cord palsy, Hypoparathyroidism


Background: The thyroid gland is normally impalpable, once enlarged it is called goiter which may be simple, toxic, inflammatory or neoplastic. Autoimmune thyroid disease (ATD) includes goiters associated with antigen antibody reaction that initiates a series of inflammatory reactions. Due to these inflammatory reactions surgeries become more difficult with a tendency to develop postoperative complications.

Methods: This is a prospective study on 207 patients with thyroid disorders who were treated with total thyroidectomy in general surgery department, Menoufia university hospital between October 2015 and December 2018. Patients were divided into two groups based on postoperative histopathological findings group A included 73 patients with autoimmune thyroid disease while group B included 134 patients with non-autoimmune thyroid disease. All patients were followed up for 6 months postoperatively to evaluate vocal cord palsy and hypoparathyroidism.

Results: In our study, the rate of temporary and permanent vocal cord palsies were 4.1% and 1.4% in ATD group respectively while in non-ATD group were 1.5% and 0.7% respectively with no statistically significant difference between both groups, whereas the rate of temporary and permanent hypoparathyroidism were 9.5% and 4.1% in ATD group respectively while in non-ATD group were 2.9% and 0.7% respectively with significantly higher rate in ATD group.

Conclusions: Surgery for ATD is a challenging procedure but safe with a low incidence of general complications and vocal cord palsy when compared with surgery for non-ATD. However, postoperative hypoparathyroidism is significantly higher due to dense adhesions which obscure the surgical field so a special attention should be paid to the parathyroid glands during total thyroidectomy. 


Dean DS, Gharib H. Epidemiology of thyroid nodules. J Best Pract Res Clin Endocrinol Metab. 2008;22(6):901-11.

Sniezek JC, Francis TB. Inflammatory thyroid disorders. J Otolaryngol Clin North Am. 2003;36(1):55-71.

McManus C, Luo J, Sippel R, Chen H. Is thyroidectomy in patients with Hashimoto thyroiditis more risky? J Surg Res. 2012;178(2):529-32.

Schneider DF, Mazeh H, Oltmann SC, Chen H, Sippel RS. Novel thyroidectomy difficulty scale correlates with operative times. World J Surg. 2014;38(8):1984-9.

Goldenberg D, Swegal W, Dunklebarger M, Pellitteri PK. Surgery for fibro-adherent inflammatory thyroid disease. Operative Techniques Otolaryngol. 2018;29:2–9.

Girgis CM, Champion BL, Wall JR. Current Concepts in Graves’ disease. Ther Adv Endocrinol Metab. 2011;2(3):135–44.

Thomusch O, Sekulla C, Billmann F, Seifert G, Dralle H, Lorenz K. Risk profile analysis and complications after surgery for autoimmune thyroid disease. BJS. 2018;105:677–85.

Wormer BA, McHenry CR. Hashimoto’s thyroiditis: Outcome of surgical resection for patients with thyromegaly and compressive symptoms. Am J Surg. 2011;201:416–9.

Shih ML, Lee JA, Hsieh CB, Yu JC, Liu HD, Kebebew E, et al. Thyroidectomy for Hashimoto’s thyroiditis: complications and associated cancers. Thyroid. 2008;18:729.

Repplinger D, Bargren A, Zhang Y, Adler J, Haymart M, Chen H. Is Hashimoto’s thyroiditis a risk factor for papillary thyroid cancer? J Surg Res. 2008;150:49.

Kurukahvecioglu O, Taneri F, Yuksel O, Aydin A, Tezel E, Onuk E. Total thyroidectomy for the treatment of Hashimoto’s thyroiditis coexisting with papillary thyroid carcinoma. Adv Ther. 2007;24:510.

Mok VM, Oltmann SC, Chen H, Sippel RS, Schneider DF. Identifying predictors of a difficult thyroidectomy. J Surg Res. 2014;190:157–63.

Shimizu K, Nakajima Y, Kitagawa W, Akasu H, Takatsu K, Ishii R, et al. Surgical therapy in Hashimioto’s thyroiditis. J Nippon Med Sch. 2003;70:34–9.

Promberger R, Hermann M, Pallikunnel SJ, Seemann R, Meusel M, Ott J. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto’s thyroiditis. Am J Surg. 2014;207(6):974–9.

Feroci F, Rettori M, Borrelli A, Coppola A, Castagnoli A, Perigli G, et al. A systematic review and meta-analysis of total thyroidectomy versus bilateral subtotal thyroidectomy for Graves’ disease. Surgery. 2014;155(3):529–40.

Enomoto K, Uchino S, Watanabe S, Enomoto Y, Noguchi S. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factor and outcome analysis. Surgery. 2014;155(3):522–8.

Stalberg P, Svensson A, Hessman O, Akerström G, Hellman P. Surgical treatment of Graves’ disease: evidence-based approach. World J Surg. 2008;32:1269–77.






Original Research Articles