Post-thyroidectomy Complications Research Articles

Predictors of post-thyroidectomy complications, a tertiary centre experience: A retrospective cohort study.

Predictors of post-thyroidectomy complications, a tertiary centre experience: A retrospective cohort study.

Artificial neural network prediction of postoperative complications in papillary thyroid microcarcinoma based on preoperative ultrasonographic features.

To predict post-thyroidectomy complications in papillary thyroid microcarcinoma (PTMC) patients using a deep learning model based on preoperative ultrasonographic features. This study addresses the global rise in PTMC incidence and the challenges in treatment decision-making with high-resolution ultrasonography. This study enrolled 1638 patients with clinically staged cN0 PTMC who received surgical treatment from 1997 to 2019 at Beijing Friendship Hospital. Deep learning model was developed using fully connected neural network. Feature selection included 1000 iterations of Bootstrap sampling and Recursive Feature Elimination (RFE) to identify the top 10 features. Data preprocessing involved normalization and imputation for missing values. SMOTE addressed class imbalance. The model was trained and tested on random data split, with performance metrics including Accuracy (ACC), Area Under the Curve (AUC), Sensitivity (SEN), and Specificity (SPE), visualized through a ROC curve and confusion matrix. The fully connected deep neural network model demonstrated high accuracy (ACC 0.81), Area Under the Curve (AUC 0.74), sensitivity (SEN 0.65), and specificity (SPE 0.83) and visualized by ROC curve and confusion matrix. These results highlight the model's reliability and potential as an effective tool in predicting postoperative complications and assisting in clinical decision-making for PTMC patients. This study highlights the potential of deep learning in enhancing medical predictions and personalized healthcare. Despite promising results, limitations include a single-center data source and unconsidered factors like lifestyle and genetics. Future research should expand data sources, include more influencing factors, and refine algorithms to improve accuracy and applicability in thyroid cancer treatment.

Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis.

Background: Transient hypoparathyroidism (TH) is the main post-thyroidectomy complication, significantly impacting surgical outcomes, hospitalization length, and perceived perceived quality of life understood as mental and physical well-being. This study aims to identify possible associated risk factors. Methods: We analyzed 238 thyroidectomies (2020-2022), excluding instances of partial surgery, primary hyperparathyroidism, neck irradiation history, and renal failure. The variables considered were as follows: demographics, histology, autoimmunity, thyroid function, pre- and postoperative Vitamin D levels (where available), type of surgery, number of incidentally removed parathyroid glands (IRP), and surgeons' experience (>1000 thyroidectomies, <500, in training). Univariate analysis applied: χ2, Fisher's exact test for categorical variables, and Student's t-test for continuous variables. Subsequently, logistic multivariate analysis with stepwise selection was performed. Results: Univariate analysis did not yield statistically significant results for the considered variables. The 'No Complications' group displayed a mean age of 55 years, whereas the TH group showed a mean age of 51 (p-value = 0.055). We considered this result to be marginally significant. Subsequently, we constructed a multivariate logistic model. This model (AIC = 245.02) indicated that the absence of incidental parathyroidectomy was associated with the age class >55 years, presenting an odds ratio (OR) of 9.015 (p-value < 0.05). Simultaneously, the age class >55 years exhibited protective effects against TH, demonstrating an OR of 0.085 (p-value < 0.01). Similarly, the absence of incidental parathyroidectomy was found to be protective against TH, with an OR of 0.208 (p-value < 0.01). Conclusions: Multivariate analysis highlighted that having "No IRP" was protective against TH, while younger age was a risk factor. Surgeon experience does not seem to correlate with IRP or outcomes, assuming there is adequate tutoring and a case volume close to 500 to ensure good results. The effect of reimplantation has not been evident in transient hypoparathyroidism.

No Change in Complications Following Thyroidectomy Despite Increase in Thyroid Cancer Surgeries: A Meta-Regression Analysis.

The increase in thyroid cancer incidence has inevitably led to an increase in thyroid cancer surgeries. This meta-regression analysis aimed to determine if the rate of post-thyroidectomy complications changes by year. PubMed and Embase databases were used to perform a systematic literature search of studies published from January 1, 2005, using the keywords "thyroidectomy" and "complication." A meta-regression was performed for post-thyroidectomy hypocalcemia and bleeding. This meta-analysis included 25 studies involving 927751 individuals. Through the years of publications in this study, there was no significant difference in the proportion of post-thyroidectomy hypocalcemia and bleeding (p=0.9978, 0.6393). Although the number of thyroid surgeries has recently increased, the incidence of post-thyroidectomy hypocalcemia and bleeding did not significantly increase.

Outcomes and predictors of complications of thyroidectomy in a scarce resource setting: Retrospective cross-sectional study

BackgroundOutcomes and predictors of complications of thyroidectomy are diverse and have been extensively studied, but data from our country and other African countries with high disease burdens are limited. ObjectiveTo evaluate the outcomes and predictors of complications of thyroidectomy among operated patients. MethodSingle institution retrospective cross-sectional study was conducted by reviewing charts from 365 patients who had undergone thyroidectomy on an elective basis between March 2018–February 2022. All patients who were admitted and underwent thyroidectomy were included in this study. Bivariate and multivariate logistic regressions were used to identify risk factors. P-value <0.05 was considered statistically significant. ResultOverall, post-thyroidectomy complications occurred in 17 % of the cases. The two most common complications were hypocalcemia and voice change; the latter being due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve with an incidence of 4.9 % and 2.5 % respectively. Thyroidectomy performed by surgical residents and having total thyroidectomy were significantly associated with overall complications of thyroidectomy. Total thyroidectomy was found to be a risk factor for postoperative hypocalcemia (AOR = 12.24 (95%CI: 4.53, 19.65); P = 0.02). Younger age of the patient (AOR =0.3(95%CI, 0.12,0.51)) and prolonged duration of presentation (AOR = 2.53(95%CI, 1.17,7.76)) were detected predictors of voice change due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve. ConclusionThe rate of thyroidectomy complications is relatively similar to other studies. In this study demographic and clinical factors associated with increased risk of complications after thyroid surgery were identified. This information will be useful for educating patients about the risks of thyroid surgery.

Incidence and Risk Factors of Post-Thyroidectomy Stridor

Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications.&#x0D; Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence.&#x0D; Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively.&#x0D; Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor.&#x0D; Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor.

Incidence and Risk Factors of Post-Thyroidectomy Stridor

Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice. Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice.

Post-Thyroidectomy Complications at St Paul’s Hospital Millennium Medical College, Ethiopia: Associated Factors and Outcomes

Post-Thyroidectomy Complications at St Paul’s Hospital Millennium Medical College, Ethiopia: Associated Factors and Outcomes

Assessment of Post-operative Complications in Patients Undergoing Thyroid Surgery in a Tertiary Care Hospital in Eastern India.

Background Thyroid surgeries, among the most common surgical procedures globally, present with varied complications. This study is aimed at identifying the complications and selected variables associated with thyroid surgery. Methods In this cross-sectional, retrospective, record-based study, a total of 107 patients who underwent thyroidectomies and satisfied the inclusion criteria, were recruited using convenience sampling technique. This study was conducted at a tertiary care hospital from January 2021 to December 2021. Data were collected from medical records using a researcher-created data extraction form after ethical approval from the institutional ethics committee. The data were analyzed using Epi Info software (Atlanta, GA: Centers for Disease Control and Prevention), with a p-value of <0.05 considered to be statistically significant. Results Of the 107 patients who underwent thyroidectomies, 92 (85.9%) reported one or more complications. Complications were most common (90.2% of patients) in the 25-34 years age group and among females (83.3%). The most common complications were dysphagia (30.84% of patients), voice change (21.50%), and respiratory obstruction (8.41%). Temporary hypocalcemia developed in 3.74% of these patients, while tracheal injury and hematoma were documented in 3.74% and 1.87%, respectively. Tobacco users (14.9%), alcohol users (16.8%), those eating a non-vegetarian diet (61.9%), and those eating saturated fats (13.0%) suffered more complications. Family history (p=0.03) was found to be significantly associated with complications. Conclusion The most common post-thyroidectomy complications in this group of patients were dysphagia and voice change, while hypocalcemia, tracheal injury, and hematoma were rare complications. Tobacco users and alcohol users reported more complications. Complications were more common in those with a family history of thyroid disease and those who were underweight.

Delayed Tracheal Perforation After Thyroidectomy: A Case Report and Literature Review.

Thyroidectomy is a safe procedure that is frequently performed for benign or malignant thyroid disease. Complications after thyroidectomy occur in approximately 3%-5% of patients. Tracheal perforation is a very rare post-thyroidectomy complication, and delayed tracheal perforation without intraoperative tracheal injury is even rarer; only 25 case reports have been published globally, with varied management. We present the case of a 36-year-old man presenting with dyspnea and cough 2weeks after left thyroidectomy. A defect measuring approximately 2cm was confirmed on the anterior wall of the trachea by computed tomography and flexible laryngoscopy. The patient's symptoms improved with conservative treatment including systemic steroids, and surgical treatment was not required. Even in the absence of unusual intraoperative events, delayed tracheal necrosis and perforation should be considered as possible postoperative complications following thyroidectomy.

Hospital volume as a predictor of outcomes following pediatric thyroidectomy.

Pediatric thyroidectomy (PT) is an uncommon procedure with a risk of significant morbidity. This study utilizes a national database to identify factors associated with short-term (30-day) post-thyroidectomy complications in children with thyroid cancer. The 2016 and 2012 Kids' Inpatient Databases (KID) were used in this study. All children with thyroid cancer undergoing thyroidectomy were included. Complications were categorized into endocrine, nervous, pulmonary, and other. Hospital volume was stratified into high-volume (performing the top 10% of total cases, HVC) or non-high-volume centers (NHVC). Risk factors were analyzed using univariable and multivariable statistical tests. Six hundred and sixty-threepatients with an average age of 15.93 years met inclusion criteria. Most patients were seen in anNHVC (90.0%) and 37.3% of thyroidectomies were performed with neck dissections. The incidence of any complication was 32.1%. Endocrine complications were the most frequent (32.7%). Independent predictors of any or only endocrine complications were age (odds ratio [OR] = 0.927, p = 0.002, any; OR = 0.926, p = 0.003, endocrine)or concurrent neck dissection (OR = 1.679, p = 0.004, any; OR = 1.683, p = 0.005, endocrine). There was no statistically significant change in odds with hospital volume. Further investigation into the effect of single surgeon versus hospital volume on the risk of complications in pediatric thyroid cancer surgery is warranted.

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study.

Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients' demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted. Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106min in group A compared to 138.5min in group B. The mean amount of intraoperative bleeding was 30ml in group A while 50ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B. The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

Horner's Syndrome and Lymphocele Following Thyroid Surgery.

Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid−related HS represents an unusual entity underling thyroid nodules/goiter/cancer−HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2−6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

Impact of Lymph Node Dissection on Postoperative Complications of Total Thyroidectomy in Patients with Thyroid Carcinoma.

Lymph node dissection (LND) in primary treatment of differentiated thyroid carcinoma is controversial. The aim of our retrospective study was to analyse the risk factors of post-thyroidectomy complications and to assess the morbidity of lymph node dissection, especially in the central neck compartment, since prophylactic central lymph node dissection has not been proven to bring an overall survival benefit. We performed a retrospective analysis of postoperative complications from 1547 consecutive patients with differentiated thyroid carcinoma in an academic department of endocrine surgery over a period of 10 years. A total of 535 patients underwent lymph node dissection, whereas the other 1012 did not. The rate of postoperative hypoparathyroidism was higher in patients with LND (17.6% vs. 11.4%, p = 0.001). No significant difference in the rate of permanent hypoparathyroidism (2.4% vs. 1.3%, p = 0.096) was observed between these two groups. A multivariate analysis was performed. Female gender, ipsilateral and bilateral central LND (CLND), parathyroid autotransplantation, and the presence of the parathyroid gland on the resected thyroid were associated with transient hypoparathyroidism. Bilateral CLND and the presence of the parathyroid gland on specimen were associated with permanent hypoparathyroidism. The rate of transient recurrent laryngeal nerve (RLN) injury (15.3% vs. 5.4%, p &lt; 0.001) and permanent RLN injury (6.5% vs. 0.9%, p &lt; 0.001) were higher in the LND group. In multivariate analysis, ipsilateral and bilateral lateral LND (LLND) were the main predictive factors of transient and permanent RLN injury. Bilateral RLN injury (2.6% vs. 0.4%, p &lt; 0.001), chyle leakage (2.4% vs. 0%, p &lt; 0.001), other nerve injuries (2.2% vs. 0%, p &lt; 0.001), and abscess (2.4% vs. 0.5%, p = 0.001) were higher in the patients with LND. The surgical technique and the extent of lymph node dissection during surgery for thyroid carcinoma increase postoperative morbidity. A wider knowledge of lymph-node-dissection-related complications associated with thyroid surgery could help surgeons to carefully evaluate the surgical and medical therapeutic options.

Early and Late Complications after Thyroid Surgery: A Retrospective Study in 163 Patients

Objective: The aim of this study was to evaluate the early and late (6 months after surgery) complications in patients undergoing thyroid surgery.&#x0D; Material &amp; methods: A retrospective study was done from January 2015 to December 2019 in the Department of ENT &amp; Head Neck Surgery, Enam Medical College &amp; Hospital. One hundred and sixty three patients with both benign &amp; malignant thyroid disease underwent surgical treatment was selected for this study. Patients were followed up for six months and peroperative &amp; postoperative complications were evaluated.&#x0D; Results: Out of 163 patients 132(80.9%) cases were benign and 31(19.1%) cases were malignant. Total thyroidectomy was done in 71(43.56%) patients and hemithyroidectomy was done in 82(50.3%) patients and 10(6.13%) patients had other thyroid surgery. 29(17.80%) patients develop complications after thyroid surgery. Most common post operative complication was hypoparathyroidism with a incidence of 17(10.43%). 15(9.20%) patients developed temporary hypocalcaemia and 2(1.23%) patients developed permanent hypocalcaemia. Others complications were recurrent laryngeal nerve (RLN) palsy 2(1.23%), superior laryngeal nerve (SLN) palsy 3(1.84%), wound infection 2(1.23%), haematoma 1(0.61%) and hypertrophied scar 4(2.45%).&#x0D; Conclusion: Hypocalcaemia was the most frequent post-thyroidectomy complication, while voice change, seroma, haematoma, wound infection and hypertrophied scar are additional complications. Surgeons have to pay attention to curtail the complications during thyroid surgery.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 50-55

Importance of proper diet after thyroidectomy in diabetic patients: A short communication

Thyroidectomy is a surgical technique used to treat cancer, noncancerous thyroid enlargement, goiter, and hyperthyroidism. It is a procedure to remove all or sections of the thyroid gland. Most importantly, some common complications are often observed, like weight gain, loss of libido, and vocal cord paresis or paralysis after thyroidectomy. After surgery, diabetic patients are more prone to comorbidities such as kidney disease, eyes health issues, hypertension, obesity, etc. This study highlighted the probable diet and essential home-based nutrition for post thyroidectomy complications. Weight gain is the common complaint of most patients who underwent surgery. Currently, there are insufficient data that do not provide clear conclusions about post-surgery diet plan. However, low carbohydrate, low fat but high veg-protein-rich diet are altogether helpful for weight loss, diabetes, and related complication. More research is needed in the medical nutrition therapies segment to get more dietary options for such patients.

Clinical study of postoperative complications of thyroidectomy

Background: Thyroid surgery is one of the common surgeries performed by general surgeons, Head and neck surgeons, and endocrine surgeons today. The most common complications of thyroid surgery are bleeding, injury to recurrent laryngeal nerves, and parathyroid glands. Other complications include airway obstruction, superior laryngeal nerve injury, infections, and sometimes thyroid crisis. Patients with permanent recurrent laryngeal nerve palsy and hypocalcaemia have life-long problems with a need for continued medication, further surgeries, and rehabilitation. They have a compromised quality of life by an increase in individual's healthcare costs and requiring lifelong alternative therapies. Objectives: To evaluate the incidence of post thyroidectomy complications. It also intends to evaluate the preoperative and intra-operative factors that contribute to these complications. To assess the modalities to prevent such complications. Methods: A Prospective study was done from January 2018 to December 2019 on thyroid complications. A total of 78 patients were studied regarding the diagnosis, type of surgery, and the complications in them. The patients were followed up for 1 year. Results: The majority of patients (59%) were in the 3rd and 4th decade of life age. Female domination more than male. Multinodular goiter is the most common diagnosis. The most common complication was transient Hypocalcaemia (15.38%) and recurrent laryngeal nerve( 6.41%). Wound infections in 6.41%and seromas are 2.56%. The incidence of major bleed with respiratory obstruction and thyrotoxicosis is zero. No permanent debilitating complications of RL nerve injury or hypocalcaemia were noted. Conclusion: A thorough preoperative preparation, with adequate knowledge of Thyroid anatomy and steps of surgery is essential. A clean dissection, meticulous haemostasis and, identification and preservation of Recurrent Laryngeal and Parathyroids can relate to a low rate of complications. Extensive surgeries are associated with a higher rate of complications. Early recognition and prompt treatment of complications enable a better outcome for the patient.

COVID-19 era and thyroid surgery

We aim to update the pandemic literature concerning thyroidectomies for benign and malign conditions. The inclusion criteria: PubMed published papers, the key words of research are “thyroidectomy” or “thyroid surgery” or “endocrine surgery” and “coronavirus”, “pandemic” or “COVID-19”. The reduction of thyroid ultrasound and fine needle aspiration is reflected in a lower volume of indications for surgery depending on the phases of pandemic and the rate of infections in general population. Imperative surgical approach is needed in cases with poor prognostic like poorly differentiated, undifferentiated, anaplastic and medullary carcinoma, while cases with well differentiated carcinoma originating from follicular cells associate a less aggressive behavior, thus the overall prognostic might not be affected if surgery is postponed. During the period of times with severe restrictions and high infection rates in general population, the delay of surgical procedures was unavoidable, thus scores of assigning the moment of operation were introduced as PAPS (Physician Assigned Priority Scoring) and MeNTS (Medically Necessary Time Sensitive). The need of assessing post-thyroidectomy complications is essential in situations when telemedicine is not a solution as severe cases of hypocalcemia, vocal folds damage, local liquid collections, etc. In conclusion, scores validation is still needed. Critical preoperatory decision takes into consideration the pandemic circumstances (COVID-19 status of the patient and of the health workers involved in the procedure). Use of digital health care systems might reduce the pre- and post-operatory burden. Overall, a reduction of thyroid surgery volume was registered during the first year of pandemic all over the world, while the procedure itself seems safe for the patient from a point of view related to the risk of coronavirus cross-infection.

Post-Thyroidectomy Hypocalcemia: A Single-Center Experience

IntroductionThyroidectomy is a frequent operation performed worldwide. The most common complication following thyroid surgery is hypocalcemia, caused by transient or persistent hypoparathyroidism. This study aimed to investigate the prevalence of hypocalcemia after thyroidectomy and to identify potential risk factors.MethodsAll thyroidectomies performed at a single tertiary center between 2012 and 2017 were retrospectively analyzed. Post-thyroidectomy hypocalcemia was evaluated in relation to risk factors such as age, sex, procedure type, and type of thyroid disease. Data were extracted from patient medical records. Patients with pre-operative hypocalcemia were excluded.ResultsWe enrolled 182 patients who underwent thyroidectomy. Female patients comprised 83% (n = 151) of the total patients. Of all patients, 116 (63.7%) had developed post-operative temporary hypocalcemia and three (1.6%) had persistent hypocalcemia. Remarkably, no cases of mortality were reported. There was no significant relationship between the occurrence of hypocalcemia and age, type of thyroid disease, and sex. Conversely, there was a significant relationship between the development of hypocalcemia and the type of procedure (P < 0.001).ConclusionThyroidectomy is a safe surgery with few complications when performed by a skilled surgeon. These complications result in longer hospital stays and higher costs. The most common post-thyroidectomy complication was hypocalcemia. Furthermore, patients who underwent total thyroidectomy were at the greatest risk of developing post-thyroidectomy hypocalcemia.

Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period.

BACKGROUND: Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent.OBJECTIVE: Summarize the frequency of surgical complications of thyroidectomy.DESIGN: Retrospective.SETTING: Secondary health facility in southwestern Saudi Arabia.PATIENTS AND METHODS: We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019.MAIN OUTCOME MEASURE: Complications following thyroidectomy.SAMPLE SIZE: 339 patients, 280 (82.6%) females and 59 (17.4%) males.RESULTS: We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma.CONCLUSION: The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications.LIMITATIONS: Retrospective design and no long-term follow up to monitor late complications.CONFLICT OF INTEREST: None.