Determining the Correlation between Types of Thyroid Surgery, Goiter Pathology and Recurrent Laryngeal Nerve Injury

Abstract

Background: Thyroidectomies are often performed surgical procedures that entail the partial or complete removal of the gland depending on the nature and pathology of the goitre. The Recurrent Laryngeal Nerve Injury (RLNI) represents nearly half of all the complications of thyroid surgery. Vocal cord paresis or paralysis, due to iatrogenic injury of the recurrent laryngeal nerve, is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of this study is to Estimate the recurrent laryngeal nerve palsy concerning different types and indications of thyroid surgery. A cohort retrospective study of 705 patients with different kinds of goiters admitted to Al-Sadder teaching hospital and Al-Ameer private hospital in Najaf city- Iraq, for thyroid surgery. The current study is based on a single surgeon's experience from 1 October 2007 to 30 June 2018, with a mean follow-up time of 37 months. Seven hundred five patients underwent various thyroidectomies for various purposes. The majority of patients have benign multinodular goitres (67.4 percent). Indications for surgery for toxic multinodular goitres, which have been observed in (19.15 percent). Malignancy was observed in (14.3%), while the least frequent reasons for surgery in our sample were Hashimoto's thyroiditis and Grave's disease (7.6%% and 3.4%), respectively. Temporary recurrent laryngeal nerve injuries have been seen in (0.69%) of subtotal surgery rising to (10%) (p=0.05), for patients having recurrent goitres. The overall permanent recurrent laryngeal nerve injuries were (0.99%) ranging from (0%) in subtotal up to (5%) (p=0.027) in cases for recurrent goitres. Total thyroidectomy is preferred since it will lessen the need for repeat surgery, which is accompanied by a considerably higher rate of nerve injury, even though partial thyroidectomy is associated with a low rate of recurrent laryngeal nerve injury.