Complications after total thyroidectomy

Abstract

The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires emergency management. Prevention of complications depends on careful operative technique and is enhanced for some teams by the use of specific techniques such as intraoperative neuromonitoring. Postsurgical hypocalcemia is managed by the administration of calcium plus vitamin D for at least 10 days. Recurrent laryngeal nerve paralysis recovers in most cases, and no invasive therapy should be performed for at least six months, except for emergency presentations; laryngeal surgery techniques may offer significant improvement if phonation or respiratory sequelae persist beyond six months, but the results are inconsistent. There should be a systematic strategy for detection of complications after thyroidectomy involving a multidisciplinary approach.

Use of optical magnification and microsurgical technique in general surgery

“…[5][6][7] Complications in thyroid surgery can be reduced by proper anatomical knowledge of the neck and using precise surgical technique. 8,9 In the last 40 years there are only a few publications in the literature about the use of microsurgery in thyroid surgery, and all emphasize the concept that microsurgery improves surgical results especially in reinterventions and in lymphadenectomy.…”

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

“…The mean thyroid volume calculated by the ellipsoid volume formula was 37.16±23.59 cm 3 . There was no difference between study groups in terms of age, thyroid volume, TSH and T4 levels (p>0.05).…”

“…Pain in the incision site is a common complaint among patients who undergo thyroidectomy, a widely applied procedure in endocrine surgery (1)(2)(3). The postoperative pain following thyroidectomy is due to extensive tissue dissection and tension during the operation (4).…”

Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

“…[1][2][3] It occurs more frequently in patients who have had a central lymph node dissection, in those in whom the parathyroid glands are not identified intraoperatively, and in those for whom the indication for surgery is Grave's disease. [4][5][6][7] Symptomatic hypocalcemia may present with peripheral or perioral paresthesia, carpopedal spasm, confusion, or life-threatening seizures, and, depending on the degree of damage to the parathyroid glands, may be transient or permanent.…”