Special issues concerning thyroid surgery

Abstract

Thyroid surgery is classified as a clean procedure and is associated with a low incidence of wound infections (0.3%). The majority of international guidelines do not recommend the use of systemic prophylactic antibiotic treatment in clean procedures. Antibiotic prophylaxis is not indicated in total thyroidectomy with or without neck dissection and should only be used in high-risk patients or when the operation is expected to last more than three hours (Ia,A). A single preoperative dose of prophylactic antibiotics must be administered 30 minutes prior to the induction of anaesthesia and should be re-administered only during the operation and if the latter exceeds three hours (Ia,A) Preoperative treatment with Lugol solution for 10 days blocks the release of thyroid hormone and significantly decreases the vascularity of the thyroid gland. Some endocrine surgeons administer Lugol solution 10 days preoperatively in order to decrease thyroid gland vascularity. However, the available studies are mostly based on empirical or indirect evaluations, such as the surgeon’s observations; consequently, objective results of the effects of Lugol solution on the thyroid gland are still difficult to achieve. The use of Lugol Solution in the preoperative preparation of patients with Grave’s Disease is acceptable (III,B). The development of DVT/PE complications in thyroidectomy has a low incidence when compared with the general surgical population. The operation is relatively short and allows immediate postoperative patient mobilization. Pharmacological prophylaxis against DVT is not necessary in thyroid surgery as the risk of postoperative bleeding is significantly greater than the risk of thromboembolism (Ib,A). Pharmacological prophylaxis against DVT is advised in high-risk patients (Ia,A). Mechanical prophylaxis against DVT is recommended in all patients as it demonstrates similar efficacy and risk reduction with pharmacological methods but without bleeding complications (Ia,A)