Increased risk of postoperative complications after total thyroidectomy with Graves' disease

Kwon, Hyungju; Kim, Jong Kyu; Lim, Woosung; Moon, Byung In; Paik, Nam Sun

doi:10.1002/hed.25484

Cited by 19 publications

(17 citation statements)

References 30 publications

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“…The a priori exclusion of thyroid reoperation and surgery for malignant disease excluded these factors from the present analysis. As already described by other authors 17,18 , the present study has confirmed that thyroiditis increases the rate of postoperative VCP. In contrast, for permanent VCP, thyroiditis is debatable as a risk factor based on the theoretical models calculated for the present cohort.…”

Section: Discussionsupporting

confidence: 92%

“…Apart from IONM, factors influencing postoperative VCP rates are thyroiditis (Graves' disease or Hashimoto's thyroiditis) 17,18 and malignancy 1,19 . Especially in thyroid malignancy, deliberate resection of the RLN for oncological reasons is inevitably associated with permanent VCP.…”

Section: Discussionmentioning

confidence: 99%

“…However, meta‐analyses 12,15,16 have concluded that use of IONM did not contribute to reduced rates of VCP. Apart from the debate on the influence of IONM, thyroiditis (Graves' disease or Hashimoto's thyroiditis) 17,18 and malignancy 1,19 have a proven effect on postoperative rates of VCP. In addition to factors influencing the complexity of the individual surgical procedure, the experience and training of the operating surgeon play an important role, which is why hospital volume is a relevant factor when considering rates of postoperative VCP 1,3,19 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study

Staubitz¹,

Watzka²,

Poplawski

et al. 2020

BJS Open

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Background: Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) predicts the risk of vocal cord palsy (VCP). IONM can be used to adapt the surgical strategy in order to prevent bilateral VCP and associated morbidity. Controversial results have been reported in the literature for the effect of IONM on rates of VCP, and large multicentre studies are required for elucidation. Methods: Patients undergoing first-time thyroidectomy for benign thyroid disease between May 2015 and January 2019, documented prospectively in the European registry EUROCRINE ® , were included in a cohort study. The influence of IONM and other factors on the development of postoperative VCP was analysed using multivariable regression analysis. Results: Of 4598 operations from 82 hospitals, 3542 (77⋅0 per cent) were performed in female patients. IONM was used in 4182 (91⋅0 per cent) of 4598 operations, independent of hospital volume. Postoperative VCP was diagnosed in 50 (1⋅1 per cent) of the 4598 patients. The use of IONM was associated with a lower risk of postoperative VCP in multivariable analysis (odds ratio (OR) 0⋅34, 95 per cent c.i. 0⋅16 to 0⋅73). Damage to the RLN noted during surgery (OR 24⋅77, 12⋅91 to 48⋅07) and thyroiditis (OR 2⋅03, 1⋅10 to 3⋅76) were associated with an increased risk of VCP. Higher hospital volume correlated with a lower rate of VCP (OR 0⋅05, 0⋅01 to 0⋅13). Conclusion: Use of IONM was associated with a low rate of postoperative VCP.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study

Staubitz¹,

Watzka²,

Poplawski

et al. 2020

BJS Open

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“…Parathyroid glands play significant roles in maintaining a good balance between serum calcium and phosphorus, but are vulnerable to be injured during surgical operation because of their small volumes and variable locations. Temporary hypoparathyroidism [1,2] was seen in more than 30% of patients undergoing total thyroidectomy, --and the incidence of permanent hypoparathyroidism (hypoparathyroidism lasting for over 6 postoperative months) was [3,4] up to 10%.…”

Section: Introductionmentioning

confidence: 99%

Research on Intra-Operative Indocyanine Green Angiography of the Parathyroid for Predicting Postoperative Hypoparathyroidism: A Noninferior Randomized Controlled Trial

Jin

Cui

2020

Endocrine Practice

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“…The major complication of thyroid resection for GD is postoperative hypoparathyroidism with transient and permanent rates between 18.0-20.0% and 3.0-7.0% [14][15][16][17], followed by postoperative bleeding and recurrent laryngeal nerve palsy (RLNP). The underlying causes are complex.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

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Increased risk of postoperative complications after total thyroidectomy with Graves' disease

Cited by 19 publications

References 30 publications

Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study

Effect of intraoperative nerve monitoring on postoperative vocal cord palsy rates after thyroidectomy: European multicentre registry-based study

Research on Intra-Operative Indocyanine Green Angiography of the Parathyroid for Predicting Postoperative Hypoparathyroidism: A Noninferior Randomized Controlled Trial

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

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