Complicaciones de la cirugía tiroidea: Control y tratamiento

Abstract

Introduction and goals: Thyroid nodules occur in 4% of the population. The most common indication for thyroid surgery is a multinodular goiter, increasing in areas with iodine deficiency. The diagnosis of thyroid carcinoma in patients operated on for multinodular goiter is between 7-14%.Thyroid cancer is the most common malignant glandular tumor. Methods: We performed a retrospective study on patients operated of thyroid pathology from 2007 to 2009 .We identified epidemiological data, surgical indication and complications of the surgery glandular as hypocalcemia or recurrent palsy. Results: A total of 139 patients were studied. The most common indications for surgery were thyroid nodule (43.88%) and multinodular goiter (38.84%). There was a 28% discrepancy between pre/postoperative results on pathological anatomy. In all these cases, preoperative FNAC (fine-needle aspiration cytology) had a result of colloid goiter, in contrast to the histopathology of the surgical specimen, in which localized foci of papillary microcarcinoma were found. After surgery 27% of patients had temporary hypocalcemia. Two cases of 139 patients showed permanent recurrent palsy. Intrathoracic goiter was identified in 15.82% of patients. Discussion and Conclusions: There must be a daily monitoring of postoperative calcium levels. We recommend treatment with calcium (oral and intravenous) if lower levels of 7.2mg/ dl or less than 8mg/dl but in patients with signs / clinical hypocalcemia. Recurrent permanent palsy were in patients operated on papillary carcinoma. The surgical approach in the case of intrathoracic goiter was cervical access without requiring sternotomy. Thyroid surgery is not without complications and permanent damage such as recurrent palsy or hypocalcemia. The experience of the otolaryngologist in cervical surgery have a key role in reducing of the complications. Indications should be performed protocols with other services such as Endocrinology.