Complications Of Thyroidectomy Research Articles

Difficult Intubation due to Ductus Thoracicus Injury: A Rare Complication of Thyroidectomy

Difficult Intubation due to Ductus Thoracicus Injury: A Rare Complication of Thyroidectomy

Thyroidectomy in high body mass index patients: A single center experience

BackgroundTo identify the correlation between high body mass index (BMI ≥ 25) and the risk of postoperative complications of thyroidectomy. MethodsA comparative study between thyroidectomy performed in normal or overweigh-obese patients has been performed. Postoperative outcomes, including hypocalcemia, laryngeal nerve palsy, bleeding, operation time and hospital stay, were evaluated. ResultsA total of 266 patients underwent total thyroidectomy were included. Of them, 104 patients had a BMI below 25 and 162 patients had a BMI ≥ 25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications, or postoperative duration of hospital stay. There was, however, a higher operative time in patients with a BMI ≥ 25. ConclusionDespite the longer operative time, thyroidectomy can be performed safely in patients with a BMI ≥ 25.

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

The majority of pediatric patients with Graves' disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves' disease treated at our center. Medical records from 81 children and adolescents with a diagnosis of Graves' disease who received definitive therapy over a 12-year period were reviewed. Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury. RAI is a safe and effective option for treatment of children and adolescents with Graves' disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves' disease. For those centers performing thyroidectomies, we recommend that each center select 1-2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

Factors influencing thyroidectomy complications

The postoperative outcome of thyroidectomies is related to factors concerning the patient, the thyroid disease, and the surgeon. ObjectivesTo analyze a clinic's experience with thyroidectomy complications. Study design: historical cross-sectional cohort study. Materials and MethodsWe reviewed the charts from 228 patients submitted to thyroidectomy, between 1991 and 2004. Transient, permanent and total complications as well as persistence and recurrence of the basal disease were studied in relation to clinical and laboratory factors. ResultsTotal complications occurred in 34.65%, transient complications in 18.86% (9.21% had hypocalcemia, 0.44% had vocal cord paralysis), associated with the first postoperative years and pressure complaints, and permanent complications in 17.98% (8.77%: hypoparathyroidism; 1.75%: vocal cord paralysis), associated with malignancy and more radical surgeries. The thyroid disease persisted in 17.98% of the cases, associated with age and recurrence in 10.96%, associated with the first operative years, benign diseases and less radical surgeries. ConclusionThe complications were associated with pressure complaints, shorter complaining period, malignancy and more radical surgeries. The recurrence was associated with the first operative years, non-neoplastic thyroid diseases and less radical surgeries. The persistence of disease was associated with older age.

Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results

Post-thyroidectomy hypocalcemia is among the most common complications of total thyroidectomy. The purpose of this study was to evaluate early predictive factors and long-term changes in intact parathyroid hormone (iPTH) levels in patients with transient and permanent hypocalcemia after total thyroidectomy. A total of 349 consecutive patients who underwent total thyroidectomy with or without neck dissection between 2009 and 2011 were reviewed. PTH, total calcium (Ca), and ionized Ca (iCa) levels were evaluated at 1 hour, and 1, 3, 5, and 7 days, and 1, 3, 6, and 12 months postoperatively. Biochemical profiles at 1 hour after total thyroidectomy in patients with transient and permanent hypocalcemia were compared. Patients with postoperative hypocalcemia were followed for 12 months. Lesser preoperative serum levels of Ca and more extensive surgery were significantly associated with postoperative hypocalcemia (P < .05). The absolute level and relative decline (%) in iPTH at 1 hour were the most reliable predictors of postoperative hypocalcemia according to the receiver operating characteristics curve, with a threshold of 10.42 pg/mL and 70%. Sensitivity and specificity of the predictors were 83.4% (95% CI, 76.4-89.1), 100% (95% CI, 84.6-100.0), 84.1 (95% CI, 77.2-89.7), and 95.5% (95% CI, 77.2-99.9), respectively. Parathyroid function recovered in the first month after total thyroidectomy in 78 of 99 patients (79%) with transient hypocalcemia. However, 46 of 61 patients (74%) with a subnormal iPTH level at 3 months after surgery had permanent hypocalcemia. Mean postoperative PTH level and the mean relative decline in PTH measured 1 hour postoperatively were the most reliable predictors of postoperative or permanent hypocalcemia.

Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy.

Postoperative hypocalcemia is a common complication of thyroidectomy. Magnesium is known to modulate serum calcium levels and hypomagnesemia may impede correction of hypocalcemia. The purpose of this study was to investigate whether hypomagnesemia after thyroidectomy has any impact on early hypocalcemia and/or permanent hypoparathyroidism. We conducted a retrospective review of prospectively maintained databases. Inclusion criteria were total or completion total thyroidectomy with postoperative magnesium levels available. The incidence of postoperative hypocalcemia was correlated with postoperative hypomagnesemia and other risk factors. Two hundred one cases were included. Twenty-six patients (13%) developed postoperative hypomagnesemia. Hypomagnesemia (p = .002), cancer diagnosis (p = .01), central neck dissection (p = .02), and inadvertent parathyroid resection (p = .02) were significantly associated with hypocalcemia. On multivariate analysis, only hypomagnesemia (p = .005) remained significant. Hypomagnesemia was also a significant predictor of permanent hypoparathyroidism (p = .0004). Hypomagnesemia is significantly associated with early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Magnesium levels should be closely monitored in patients with postthyroidectomy hypocalcemia.

259. Parathyroid Hormone Gene Modified Mesenchymal Stem Cells for Hypoparathyroidism

Hypoparathyroidism is a prominent complication of total thyroidectomy for thyroid cancer. Hypocalcemia significantly decrease the quality of life of patients with hypoparathyroidism. Medical management with calcium supplements and activated vitamin D analogues increase risk of renal complications. Hormone replacement is an alternative. In this study, we investigated the possibility of management hypoparathyroidism using parathyroid hormone gene modified mesenchymal stem cells. Rat model of hypoparathyroidism was established through parathyroid gland removing by operation. Human prepro-PTH gene was amplified by RT-PCR from parathyroid adenoma and cloned into lentiviral vector. In order to express functional PTH by non-parathyroid cells. Specific mutation was introduced into the prepro-PTH gene. PTH expression was determined after transfection of 293T cells with the vector. Rat adipose tissue-derived mesenchymal stem cells were cultured and infected with PTH gene-expressing lentiviral vectors. The therapeutic effect of PTH gene modified MSCs on experimental hypoparathyroidism will be presented.

Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience.

Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Hypocalcemia, the most common complication of thyroidectomy, is a transient condition in up to 27% of patients and a permanent condition approximately 1% of patients. The aim of this prospective study was to evaluate reliability of postoperative intact parathyroid hormone (iPTH) assessment for predicting clinically relevant postthyroidectomy hypocalcemia for a safe early discharge of patients with no overtreatment. Seventy-five consecutive patients (age 51 ± 13 years [mean ± SD]) undergoing total or completion thyroidectomy with no concomitant parathyroid diseases or renal failure were included in the present study. Serum iPTH level was determined before and 2 hours after thyroidectomy. Serum calcium concentration was determined 1 day before and 2 days postoperatively. The occurrence of postoperative hypocalcemia was correlated both with the absolute and relative iPTH decrease, determined as a ratio of the preoperative value (P < .0001). There was a greater difference in relative decrease in iPTH between patients remaining normocalcemic and those with hypocalcemia present on the second postoperative day. Hypocalcemic patients on the second postoperative day had a 62% relative decrease in iPTH 2 hours after thyroidectomy. The relative decrease in serum iPTH was greater in patients with hypocalcemia arising on the second postoperative day rather than in patients who remained normocalcemic. The relative decrease in iPTH determined 2 hours after total thyroidectomy together with the serum calcium concentration 24 hours after thyroidectomy proved to be useful predictors of sustained hypocalcemia and might change the clinical management of patients after thyroid surgery to support a longer hospitalization in these selected patients.

Special issues concerning thyroid surgery

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)

Multiple Rare Complications Following Total Thyroidectomy and Bilateral Neck Dissection: Case Report and Literature Review

Background: Thyroidectomy is a common and safe surgical procedure and is typically associated with low morbidity and mortality. Delayed tracheal rupture after thyroidectomy has only infrequently been reported. Here we are reporting a case in which a number of rare complications of total thyroidectomy and neck dissection happened over a very short period of time with a review of existing literature. Case presentation: A 48-year-old man, diagnosed as metastatic papillary thyroid cancer. Underwent total thyroidectomy and bilateral modified neck dissection complicated by severe bronchospasm, bilateral pneumothorax, pneumomediastinum, pneumopericardium managed by underwater seal drainage of his chest cavities. On the 10th postoperative day he developed spontaneous tracheal rupture which compromised his airway. He was coded, eventually intubated resuscitated. In the operating room he had his neck explored, neck haematoma evacuated, tracheal tear debrided and a tracheostomy tube was inserted. Conclusion: Thyroidectomy remain a commonly performed safe surgery typically associated with low mortality and morbidity. However other rare and serious complications as observed in this case can sometimes take place and can be life threatening. Bilateral pneumothorax, pneumomediastinum and pneumopericardium are examples of such serious complications. Multiple contributing factors include heavy smoking, alleged barotrauma, and extensive electrocautery dissection. In our case the late spontaneous rupture of the trachea most likely been predisposed to by the excessive explosive smokers cough.

Management of complications after thyroid surgery

The evolution of thyroid surgery has decreased the incidence of complications significantly. Experienced endocrine surgeons report less than 1% of complications. However, laryngeal nerve injury and hypocalcaemia still occur. Less common complications of thyroidectomy include postoperative bleeding, major thoracic duct injury, and even more rarely tracheal injury and oesophageal injury. In cases of postoperative voice change or hoarseness, the patient should be evaluated with direct laryngoscopy to define the extent of injury and the course of treatment. Steroids may be used. The patient should be followed up until complete resolution of nerve palsy. If the laryngeal nerve injury is considered permanent, operative treatment may be considered by referral centres with expertise. Swallowing studies and voice therapy should also be initiated. Post-thyroidectomy bleeding may be life-threatening and requires an emergency reoperation to decompress the upper airway. Injury of the major thoracic duct may be managed with either conservative or operative treatment based on the amount of daily lymphorrhea. Injury of the trachea and/or oesophagus usually requires surgical repair. The above complications require an immediate and stepwise therapeutic approach from the vigilant surgeon. Although the prevention of those complications remains the first goal of the surgeon, if such complications are encountered, the surgeon should implement the most appropriate intervention according to the above recommended management guidelines.

The preoperative evaluation prevent the postoperative complications of thyroidectomy.

ObjectiveThyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications.MethodsA nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics.ResultsEighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively.ConclusionsThe success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

Differential recurrent laryngeal nerve palsy rates after thyroidectomy

Recurrent laryngeal nerve (RLN) palsy is a devastating complication of thyroidectomy. Although neurapraxia is thought to be the most common cause, the underlying mechanisms are poorly understood. The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy. Thyroidectomy data were collected, including demographics, change in RLN diameter, and RLN electromyographic (EMG) reading. Left and right RLNs, as well as bilateral and unilateral subgroup analyses were performed. A total of 5,334 RLNs were at risk in 3,408 thyroidectomies in this study. The overall RLN palsy rate was 1.5%, greater on the right side than the left for bilateral cases (P = .025), and greater on the left side than the right for unilateral cases (P = .007). In a subgroup of 519 RLNs, the diameter and EMG amplitude were measured. The RLN diameter increased by approximately 1.5-fold (P < .001), and corresponded to increased EMG amplitude (P = .01) during the procedure. The diameter of the right RLN was larger than the left RLN, both at the beginning and end of the dissection (P = .001). The right-left differential rates of post-thyroidectomy RLN palsy seemed to be due in part to differential RLN diameters, with stretch having a more deleterious effect on RLNs with a smaller diameter; also, edema as a result of stretch might be an underlying mechanism for postoperative neurapraxia and palsy. Thyroid surgeons should be aware of the different vulnerabilities of each RLN and develop practices to avoid iatrogenic injury.

Thyroidectomy in patients with a high BMI: a safe surgery?

To study and compare the specific postoperative complications of thyroidectomy in a population with a BMI ≥25 with a population having a BMI below 25. A prospective study was carried out from September 2010 to January 2013. Postoperative calcemia, laryngeal mobility, bleeding or infectious complications, postoperative hospital stay, and operation time were studied and compared statistically by a χ(2)-test or Student's t-test. A total of 240 patients underwent total thyroidectomy and 126 underwent a partial thyroidectomy. Of them, 168 patients had a BMI below 25 and 198 patients had a BMI ≥25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications, or postoperative duration of hospital stay. There was, however, a significant operative time in patients with a BMI ≥25. Despite the longer operative time, thyroidectomy (total or partial) can be performed safely in patients with a BMI ≥25.

Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients

Postoperative hypocalcemia is the most frequent complication of total thyroidectomy. It may have a delayed onset, and therefore delays the discharge from the hospital, requiring calcium replacement therapy to alleviate clinical symptoms. During a 7-month period, 2,631 consecutive patients undergoing primary or completion thyroidectomy were prospectively followed up and underwent analysis regarding postoperative hypoparathyroidism. Data were prospectively collected by questionnaires from 39 Italian endocrine surgery units affiliated to the Italian Endocrine Surgery Units Association (Club delle Unità di EndocrinoChirurgia-UEC), where thyroid surgery is routinely performed. The incidence of hypoparathyroidism was 28.8 % (757 patients), including transient hypocalcemia (27.9 %-734 patients) and permanent hypocalcemia (0.9 %-23 patients). The rate of asymptomatic hypocalcemia was 70.80 %. The incidence of permanent hypocalcemia was higher in the symptomatic hypocalcemia group (7.5 %) than in asymptomatic one (1.5 %). Female patients experienced a transient postoperative hypocalcemia more frequently than male patients (29.7 and 21.2 %, respectively; p < 0.0001). The percentage developing hypocalcemia in patients in which parathyroid glands were intraoperatively identified and preserved was higher than in the patients in which the identification of parathyroid glands was not achieved (29.2 vs. 18.7 %, p < 0.01). This prospective study confirmed the main risk factors for postoperative hypocalcemia: thyroid cancer, nodal dissection, and female gender. It farther showed that identifying parathyroids has an important role to prevent permanent hypocalcemia though with a higher risk of transient hypocalcemia. A suitable informed consent should especially emphasize the importance of some primary factors in increasing the risk of hypocalcemia after thyroid surgery.

Hoarseness after thyroidectomy: blame the endocrine surgeon alone?

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. We reviewed the literature aiming to explore these potential surgical and non-surgical causes of hoarseness beyond thyroidectomy and the role of the endocrine surgeon. Is he/she alone to blame? The MEDLINE/PubMed database was searched for publications with the medical subject heading "hoarseness" and keywords "thyroidectomy", "RLN", "VCD" or "intubation". We restricted our search till up to May 2013. In our final review we included 80 articles and abstracts that were accessible and available in English. We demonstrated the incidence of hoarseness stemming from surgical and non-surgical causes and also highlighted the role of intubation as a potential cause of injury-related VCD. Hoarseness is a relatively common complication of thyroidectomy, which can be attributed to many factors including surgeon's error or injuries during intubation as well as to other non-surgical causes. However, compared to procedures such as cervical spine surgery, mediastinal surgery, esophagectomy and endarterectomy, thyroidectomy would seem to be a procedure with a relatively low rate of recurrent laryngeal nerve palsies (RLNPs). It is often difficult to determine whether the degree of hoarseness after thyroidectomy should be attributed only the surgical procedure itself or to other causes, for example intubation and extubation maneuvers. The differential diagnosis of postoperative hoarseness requires the use of specific tools, such as stroboscopy and intra- and extralaryngeal electromyography, while methods like acoustic voice analysis, with estimation of maximum phonation time and phonation frequency range, can distinguish between objective and subjective deterioration in the voice. The importance of medical history should be also emphasized.

Therapeutic Management in Proximal Tracheal Rupture during Total Thyroidectomy

Tracheal disruption is a life-threatening rare complication of total thyroidectomy that it should be prevented. The own-patient risk factors, procedure of tracheal intubation and a meticulous surgical technique are three main keys to keep in mind. Both medical and surgical management of this injury depends on its size, location and patient’s symptoms although neither of them prevents late complications. An early diagnosis could improve with prognosis although it is mandatory to perform either respiratory functional or imaging study in order to assume its healing. When the tracheal laceration is diagnosed during the surgery, we should take care with a continuous monitoring of the patient’s vital signs. A good oxygenation will be succeeded in high volume and low pressure with endotracheal tube distal to the lesion. We advice placing a tube drain near the disruption to prevent emphysema and an early extubation to avoid an ischaemic damage of the mucosa. A postoperative suspicion of tracheal rupture could demand reintubation with the patient in full relaxation and an examination by CT-scan or fiberscope before deciding a simple supportive therapy. We present our therapeutic experience in a female patient who suffered from tracheal injury during total thyroidectomy and describe a review of literature.

Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it?

A permanent hypoparathyroidism is a problematic complication of total thyroidectomy. In this study, we investigated its incidence and how to avoid it at the time of completion total thyroidectomy after hemithyroidectomy. Eight of the 154 patients who underwent completion total thyroidectomy as the second surgery (5%) after hemithyroidectomy (two-surgery group) showed a permanent hypothyroidism. Patients without parathyroid autotransplantation either at initial or second surgery were more likely to show a permanent hypoparathyroidism. In the subset of 74 patients in two-surgery group, who underwent bilateral central dissection, 6 (8%) had a permanent hypoparathyroidism. The incidence was higher than those in control group who underwent total thyroidectomy with bilateral central dissection at one time, which was 2%. However, all 6 patients showing a permanent hypoparathyroidsm underwent bilateral central dissection in initial surgery and none of the patients who underwent bilateral central dissection in twice had a permanent hypoparathyroidism. Taken together, we can conclude that 1) in initial surgery of hemithyroidectomy, we have to carefully search the parathyroid glands and if dissected, they should retrieved and autotransplanted to save the patients from a permanent hypoparathyroidism when they undergo second surgery in future, and 2) hemithyroidectomy with bilateral central dissection significantly increases the risk of permanent hypoparathyroidism and only ipsilateral dissection is better when we do not perform total thyroidectomy.

Combination of Surgical Subcision and Intralesional Corticosteroid Injection As a Cost-Effective and Minimally Invasive Treatment for Postoperative Adhesive Thyroidectomy Scars

Postoperative adhesive symptoms (swallowing difficulty or pulling sensation during neck extension) are one of the major complications of thyroidectomy. Moreover, adhesive scars are often visible and cause cosmetic concerns. To evaluate the efficacy and safety of combined treatment with surgical subcision and intralesional corticosteroid injection for postoperative adhesive thyroidectomy scars. A retrospective analysis was performed of 16 Korean patients with postoperative adhesive thyroidectomy scars treated with three sessions of surgical subcision and intralesional corticosteroid injection. The Vancouver Scar Scale score decreased significantly after treatment (P<.001). Follow-up revealed that six of the 16 patients (37.5%) had clinical improvement of 51% to 75%, six (37.5%) had moderate clinical improvement of 26% to 50%, and three (18.8%) had improvement of 76% to 100%; one patient (6.3%) demonstrated minimal to no improvement. After three sessions of treatment, the mean clinical improvement grade was 2.68, which means moderate to marked improvement compared to before treatment. Post-treatment erythema was observed in most patients, and notable bruising after treatment observed in five patients resolved spontaneously within 7days. Combined treatment with surgical subcision and intralesional corticosteroid injection is a cost-effective and minimally invasive treatment for postoperative adhesive thyroidectomy scars.