Complications of Thyroid Surgery: Analysis of a Multicentric Study on 14,934 Patients Operated on in Italy over 5 Years

Abstract

Complication rates associated with thyroid surgery can be evaluated only through analysis of case studies and follow-up data. This study covers postoperative data from 14,934 patients subjected to a follow-up of 5 years. Among them, 3130 (20.9%) underwent total lobectomy (TL), 9599 (64.3%) total thyroidectomy (TT), 1448 (9.7%) subtotal thyroidectomy with a monolateral remnant (MRST), and 757 (5.1%) subtotal thyroidectomy with bilateral remnants (BRST). A total of 6% of the patients had already been operated on. Persistent hypoparathyroidism occurred after 1.7% of all the operations, and temporary hypoparathyroidism was noted in 8.3%. Permanent palsy of the laryngeal recurrent nerve (LRN) occurred in 1.0% of patients, transient palsy in 2.0%, and diplegia in 0.4%. The superior laryngeal nerve was damaged in 3.7%; dysphagia occurred in 1.4% of cases, hemorrhage in 1.2%, and wound infection in 0.3%. No deaths were reported. A significant rate of LRN damage was noted, which has an important impact on the patient's social life. Hypoparathyroidism after total thyroidectomy is an important complication that can be successfully treated by therapy, although it is not always easily managed in special circumstances such as in young persons or pregnant women. The complications associated with thyroid surgery must be kept in mind so the surgeon can carefully evaluate the surgical and medical therapeutic options, have more precise surgical indications, and be able to give the patient adequate information.

Permanent hypocalcemia in patients operated for thyroid carcinoma

“…In a study by Thomusch et al more extensive surgery increased the relative risk of permanent hypocalcemia by 1.5-1.8 times [6]. However, in some other studies, it was concluded that more radical surgery did not result in higher rates of hypoparathyroidism [10,11]. In our study, when subtotal thyroidectomy was compared with total thyroidectomy, the extent of the surgery did not increase the permanent hypocalcemia rates.…”

The Factors Related with Postoperative Complications in Benign Nodular Thyroid Surgery

“…They manifest as a lowered voice tone, vocal fatigue and difficulty in singing note intonation [25].…”

Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement

“…Partial/total thyroid surgery has so far constituted the only therapeutic approach for these. Although surgery is widely available, highly effective, and safe in skilled centers, complications (both temporary and permanent) still occur in 2-10 % of cases [5,6]. Hypothyroidism is an unavoidable effect after total thyroidectomy, requiring lifelong L-thyroxine replacement therapy.…”