Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period

BACKGROUND: Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent. OBJECTIVE: Summarize the frequency of surgical complications of thyroidectomy. DESIGN: Retrospective. SETTING: Secondary health facility in southwestern Saudi Arabia. PATIENTS AND METHODS: We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019. MAIN OUTCOME MEASURE: Complications following thyroidectomy. SAMPLE SIZE: 339 patients, 280 (82.6%) females and 59 (17.4%) males. RESULTS: We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma. CONCLUSION: The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications. LIMITATIONS: Retrospective design and no long-term follow up to monitor late complications. CONFLICT OF INTEREST: None.

Analysis of complications of surgical treatment of patients with autoimmune thyroiditis

Aim — to study the frequency and structure of specific complications in surgeries for autoimmune thyroiditis AIT associated with benign nodules in comparison with operations for multinodular non-toxic goiter. Materials and methods. The analysis of complications of thyroidectomy was performed for 237 patients operated for AIT (main group) and 261 for multinodular non-toxic goiter (control group). The evaluation was done to assess thesurgeryduration, the frequency of laryngeal paresis, postoperative hypoparathyroidism, thoracic duct damage, intense neck hematomas, dysphagia and changes in voice tone. Results. More complications were found in patients of the main group — 33 against 20 in the control group. The structure and number of individual complications from their total number in both groups was the same, and the frequency of the number of operated patients was significantly higher in the group of patients with AIT. The duration of thyroidectomy in AIT was (174.3 ± 4.2) min and depended on the severity of inflammatory changes in the gland and tissues around it, and in cases of multinodular non-toxic goiter — (127.0 ± 4.7) min (p < 0.01). Conclusions. Thyroidectomy for AIT compared to multinodular non-toxic goiter is accompanied by a greater number of complications and duration of surgery. There is an increased risk of developing hypoparathyroidism, laryngeal paresis, thoracic duct injuries, severe neck hematomas, dysphagia and changes in voice tone.

Nonrecurrent laryngeal nerve-an anatomical deviation

<p>Thyroidectomy is one of the most dispute and discussed surgery. Identification of recurrent laryngeal nerve is the most important step in this surgery. Among postop complications of thyroidectomy, the commoner is haematoma, transient hypocalcaemia and hoarseness.<strong> </strong>We report a rare case of nonrecurrent laryngeal nerve in a 25-year-old male with swelling in the right thyroid lobe. A 25-year-old male presented to the ENT OPD with complaints of swelling in thyroid region for 6 months with no other symptoms. On examination there was a 2×3 cm size nodule in the right lobe of thyroid. Rest of ORL examination was normal. On ultrasonogram there was an enlarged right lobe of thyroid with a nodular goitre. Fine needle aspiration cytology showed colloid goitre. Patient was planned for right hemithyroidectomy. Right side type 1 nonrecurrent laryngeal nerve was identified at the level of superior pole of thyroid branching from vagus and entering the larynx at the level of cricothyroid joint was identified intraoperatively.<strong> </strong>In conclusion, nonrecurrent laryngeal nerve though a very rare anomaly forms a crucial anatomical structure in thyroid surgery and is prone to injury. It is one of the preventable complications during thyroid surgery leading to postop vocal cord palsy. An in-depth anatomical knowledge and diligent surgical technique will help in identification and preservation of nonrecurrent laryngeal nerve.</p>

Intraoperative Nerve Monitoring in Thyroidectomies for Malignancy: Does it Matter?

Background Recurrent laryngeal nerve (RLN) injury and postoperative hypocalcemia are potential complications of thyroidectomy, particularly in malignancy. Intraoperative nerve monitoring (IONM) remains controversial. We sought to evaluate the impact of IONM on these complications using a national data set. Methods The American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted data set was queried for patients who underwent thyroidectomies from 2016 to 2017. Patients were grouped according to IONM use. Logistic regression models were constructed to evaluate associations of variables with 30-day hypocalcemic events (HCEs) and RLN injury. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). A subgroup analysis was performed of patients with malignancy. Results A total of 9527 patients were identified; 5969 (62.7%) underwent thyroidectomy with IONM and 3558 (37.3%) without. By multivariable analysis, IONM had protective associations with HCE (OR = .81, 95% CI = .68-.96; P = .013) and RLN injury (OR = .83, 95% CI = .69-.98; P = .033). Malignancy increased risk of HCE (OR = 1.21, 95% CI=1.01-1.45; P = .038) and RLN injury (OR = 1.22, 95% CI = 1.02-1.46; P = .034). A large proportion (5943/9527, 62.4%) of patients had malignancy; 3646 (61.3%) underwent thyroidectomy with IONM and 2297 (38.7%) without. In the subgroup analysis, IONM had stronger protective associations with HCE (OR = .73, 95% CI = .60-.90; P = .003) and RLN injury (OR = .76, 95% CI = .62-.94; P = .012). Discussion Malignancy was associated with increased risk of HCE and RLN injury. Intraoperative nerve monitoring had a protective association with HCE and RLN injury, both overall, and in the malignant subgroup. Intraoperative nerve monitoring was correlated with improved thyroidectomy outcomes, especially if the indication was malignancy. This warrants further study to clarify cause and effect.

Serum calcium slope is a predictor of post-thyroidectomy hypocalcemia

Background: Hypocalcemia is a common complication following thyroidectomy. The effects of hypocalcemia can range from simple numbness to life-threatening seizures. Barring stridor, haemorrhage and hypocalcemia, other complications of thyroidectomy are not seriously morbid and hence patients can be sent home. This study sought to determine whether early postoperative calcium levels can predict hypocalcemia following thyroidectomy, to help decide on early discharge.Methods: This was a prospective cohort study, conducted between July 2016 and June 2017 among 80 consecutive patients who underwent total thyroidectomy in our department. Serum calcium values were obtained pre-operatively and at 6 and 24 hours post-operatively. Serum calcium slopes were calculated and the receiver operating characteristic curve constructed to evaluate the accuracy of risk prediction.Results: The mean total calcium levels of patients with hypocalcemia were significantly lower than the levels of the normocalcemic group. The slope of change between total calcium measurements at 6 and 24 hours in patients with hypocalcemia was found to be significantly steeper than the slope in the case of normocalcemic patients.Conclusions: It is possible to predict post-thyroidectomy hypocalcemia based on the characteristics of the early post-operative serum calcium slope. On the basis of the slope’s features, all patients except those at risk can be safely discharged home early. This can cut down on the patients’ total cost of treatment as well as save unnecessary wastage of health resources.

Quality of life of patients after total and subtotal thyroidectomy

Introduction: Thyroid diseases, especially those that require surgical treatment, are an extremely strong emotional stimulus for the patient. They evoke not only anxiety disorders, but also in the case of complications (especially those long-lasting) can even generate depressive disorders, or significantly affect the patient’s self-esteem, and thus its functioning at the social level. Aim of the study: The objective of the study was to examine the quality of life of patients who underwent surgical treatment of total and subtotal thyroidectomy. Material and methods: The study was conducted in a group of 102 patients undergoing surgery at the General Surgery Ward of the Hospital. St. Łukasz in Tarnów in the period from December 2018 to April 2019, as well as residents of Małopolska, who had performed thyroidectomy. In research have been used ThyPROpl, VAS Scale, and self-prepared questionnaires. Results and conclusions: The most common complications of thyroidectomy were tingling and numbness around the mouth and limbs (42.2%). Patients who had symptoms of tetany had a reduced perception of quality of life and health, as well as the quality of life in all its areas. The respondents had a degraded, reduced quality of life in terms of the negative impact of the disease on life (62.01) and fatigue (56.23). The greater the intensity of pain, the lower the quality of life of patients after thyroidectomy. Conclusions. There is the relationship between the quality of life and the number of complications, as well as the severity of pain. This dependence is directly proportional.

Indications and complications of thyroidectomy in Al-Ramadi teaching hospital

Thyroidectomy is one of the common operations performed worldwide. It is a main option of treatment for different benign and malignant thyroid problems. Despite improvements in procedures have decreased mortality and even and morbidity rates to a minimum; however, postoperative complications remain a major concern among surgeons. We aimed to evaluate the indications and complications of thyroidectomy. A Prospective study was conducted at Al-Ramadi Teaching Hospital/Ramadi city/Iraq during the period from January 2009 to January 2010. There were 130 patients underwent thyroidectomy. A demographic and clinical data for each patient was recorded to assess indications and complications of different types of thyroidectomies. The majority of the patients were females (93{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). The most age group affected was 21-30 years (41.54{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). Pressure symptoms were accounting for 61.54{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47} of the indications. Thyroid enlargement in euthyroid states (80{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) was the common presenting state. Subtotal thyroidectomy (58.46{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) was the commonest procedure. Out of 130 patients, 36 patients (27.69{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) were suffered from complications. The 2 most common complications encountered in the study were hypocalcemia (61.11{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) and recurrent laryngeal nerve palsy (5.38{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). In conclusion, subtotal thyroidectomy is a common procedure in our hospital. Compressive complaints were the most common indication. Hypocalcemia and recurrent laryngeal nerve palsy were the 2 most postoperative complications.

Frequency of post-operative complications of thyroidectomy.

Objectives: The objective of this study is to determine the frequency of post-operative complications of thyroidectomy. Study Design: Observational study. Setting: LUMHS Jamshoro at the Surgery Department. Period: January 2016 to December 2017. Material and Method: During these two years all the patients visiting surgery department with thyroid swelling were assessed. Assessment of thyroid swelling was done by detailed history and clinical examination. For further assessment of the swelling thyroid function tests (serum T3, T4, TSH level), ultrasound, isotope scanning and FNAC was performed. Assessed post-operative complications of thyroidectomy. Results: After assessment thyroidectomy was performed in 143 patients. Among them there were 37 males and 106 females. The ages of patients were in the range of 15-55 years and mean age was found to be 38 years. All of these patients have visited us due to complain of thyroid swelling. After complete assessment it was found that most commonly diagnosed thyroid swelling was multinodular goitre (51.04%). On ultrasound findings 60% of patients showed solid consistency whereas cystic and mixed were found in less patients. Post-operative complications were found in 61 patients (42.6%). Hypocalcaemia was the most frequent complication found in 14.68% of patients. Conclusion: Thyroidectomy is a commonly performed procedure in endocrine surgery with low morbidity and mortality. Despite improvements in surgical techniques and anaesthetic equipment, the rate of complications in thyroidectomy is constant. Post-operative measurement of calcium levels in susceptible patients can prevent tetany and emergency room admissions.

Incidental presence of non recurrent laryngeal nerve in our series of thyroidectomy

<p class="abstract"><strong>Background:</strong> Recurrent laryngeal nerve (RLN) injury is one of the most important and preventable complications of thyroidectomy which is the cause of post-operative iatrogenic vocal cord paralysis. The non-recurrent laryngeal nerve (NRLN), which is found in 0.25–0.99 of the patients who undergo thyroid surgery, is a rare embryologically-derived variant of the recurrent laryngeal nerve (RLN). Identification and prevention of injury to the laryngeal nerve is very important in thyroid surgery. The objective of the study was to highlight the incidence of Non-recurrent laryngeal nerve in our series of thyroidectomy cases.</p><p class="abstract"><strong>Methods:</strong> In the Department of Otorhinolaryngology, Pondicherry a retrospective analysis of all the thyroid surgeries that were operated between August 2006-November 2018 for various indications on a total of 1006 patients was done with specific interest in the lookout for anatomical variant of recurrent laryngeal nerve and findings were recorded. </p><p class="abstract"><strong>Results:</strong> Among all the cases, two patients with MNG who had underwent Total thyroidectomy were found to have anatomical variants of recurrent laryngeal nerve (non recurrent laryngeal nerve) intra operatively.</p><p class="abstract"><strong>Conclusions:</strong> The NRLN is a rare finding and is associated to an increased risk in iatrogenic injury especially during thyroid surgeries unless thorough anatomical knowledge and cautious dissection is not done.</p><p> </p>