Total thyroidectomy: Complications and technique

Abstract

During the 27-year period from 1957 to 1984, four hundred thirty patients underwent total thyroidectomies for malignant or benign disease of the thyroid gland at our institutions. Thyroid cancer was found in 83.4% of cases, and 47.2% of these had concomitant lymph node dissections. Transient recurrent laryngeal nerve injury occurred in 6.2% of the entire series. Permanent unilateral vocal cord paralysis occurred in 2.5% of the patients operated on, although only 1 patient (0.45 %) sustained this complication in the past 14 years. No patient had permanent bilateral vocal cord paralysis. Transient hypoparathyroidism was seen in 16.8% of patients with permanent hypoparathyroidism occurring in 4.0%. The incidence of permanent hypoparathyroidism fell to 2.7% during the past 14 years and was directly related to the extent of thyroid cancer found at operation. Postoperative complications decrease with the experience of the surgeon and increase with reoperations and extensive disease. Total thyroidectomy continues to be our treatment of choice for thyroid cancer.

Multicentricidade no carcinoma diferenciado da tireóide

“…Another complication that has enjoyed some attention is hypoparathyroidism which, in our series, was present in 9.5% of the cases, matching the literature information, which varies from 0 to 16.8% 3,4,6,7,9,12 . In one case, this complication was temporary, it reverted 35 days later with specific treatment, and such fact was shown by other authors 4,6,9 .…”

“…In one case, this complication was temporary, it reverted 35 days later with specific treatment, and such fact was shown by other authors 4,6,9 . De Jong et al showed that hypoparathyroidism was present in 3% of the patients who were submitted to total completion thyroidectomy and used vitamin D and calcium for some months with clinical signs and symptoms reversion.…”

“…Most of the series studied have advocated total thyroidectomy for the surgical treatment of the thyroid differentiated carcinoma, simply because this procedure has advantages, such as: a greater sensitivity regarding the level of thyroglobulin to assess the recurrent disease, especially distant ones; ease of detection and ablation for distant metastasis by radiotherapy; prevent the possibility of residual thyroid differentiated carcinoma to turn anaplastic; and greater survival with a lower rate of recurrence [3][4][5][6][7][8][9][10][11][12][13][14] .…”

“…Thus, thyroidectomy completion has, once more, its importance and, if carried out by a competent team, carries low morbidity. Among the complications mentioned, dysphonia as a consequence of the recurrent laryngeal nerve involvement has been found in an incidence of 0 to 5% 4,6,7,9,10,12 . However, in most cases, dysphonia is transitory, as it happened in our series.…”

Permanent hypocalcemia in patients operated for thyroid carcinoma

“…Several thyroid conditions such as Graves' disease, recurrent thyroid disease, and thyroid carcinoma carry a higher risk of postoperatively developing transient and permanent hypocalcemia [4]. The reported complication rate for permanent hypocalcemia varies signifi cantly, ranging from 0.5 to 11.0% [5]. Different types of surgeries and benign and malignant thyroid diseases in the same series make the description of related risk factors diffi cult.…”