STUDY OF FACTORS INFLUENCING EARLY POST OPERATIVE MORBIDITY AFTER THYROIDECTOMY: A DESCRIPTIVE STUDY

Gaurav Panchal, Nilanjan Roy

Abstract


Background: Thyroid disorders are the most common cause of metabolic disturbances with surgery as the mainstay treatment of many thyroid swellings. While complications following surgical removal of thyroid gland are rare, their consequences can often be debilitating & even life threatening. Patients who develop complications such as permanent hypocalcemia and RLN (Recurrent Laryngeal nerve) injury have a diminished quality of life and often require lifelong replacement therapy, further surgical procedures & rehabilitation. This study intend to assess the occurrence of various post operative complications following different thyroidectomy procedures & the role of adequate preoperative preparation for providing the patient with best chance of a satisfactory outcome.

Method: This is a descriptive observational study carried out between July 2017 and July 2019, on 60 consecutive cases who underwent thyroidectomy at a tertiary care centre.

Result: The average age of the participants who underwent thyroid surgery was 42.5167 years with a standard deviation of + 13.6649. Out of a total of 60 patients 48 were females corresponding to 80% of the study subjects; whereas males were 12 in number accounting for 20% of the study subjects showing predominantly female predisposition. Of the 60 patients, 17 had co-morbidities corresponding to 28.3% of the study subjects. Diffuse swelling of neck was the most common presenting complaint seen in 56.67% of patients. 56 patients were in Euthyroid state corresponding to 93.33%. Two patients each were hypothyroid and hyperthyroid state corresponding to 3.33% each. Total malignancies identified were 11 after histopathological examination after thyroidectomy. 9 patients had complications subsequent to the surgery. This corresponds to a rate of 15% of the study population. Hoarseness of the voice was athe commonest complication in the patients.

Conclusion: This study data revealed the rate of complications subsequent to thyroidectomy was 15%. Hoarseness of voice and hypocalcemic tetany are the common complications noted in post operative period. No rare complication was noted during the study.


Keywords


– RLN, hypocalcemic tetany, hoarseness of voice

Full Text:

PDF

References


S. Standring, Gray's Anatomy: The Anatomical Basis of Clinical Practice, Elsevier, London, UK, 39th edition, 2008.

Cotran RS, Kumar V, Robins SI. The thyroid in Robins, SI. ed. Pathological bases of disease. Philadelphia W. B. Saunders Company 5th edition 1994.

Jones AJ, Aitman TJ, Edmonds CJ, Burke M, Hudson E, Tellez M. Comparison of fine needle aspiration cytology, radioisotopic and ultrasound scanning in the management of thyroid nodules. Postgrad Med J. 1990 Nov;66(781):914-7

Bergenfelz A, Jansson S, Kristofferson A et al (2008) Complication to thyroid surgery: results are reported in a database from a multicenter audit comprising 3660 patients. Langenbecks Arch Surg 393:667–673

Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT (2011) Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope 121:1009–1017

Sheahan P., O'Connor A., Murphy M. Comparison of incidence of postoperative seroma between flapless and conventional techniques for thyroidectomy: a case–control study. Clin. Otolaryngol. 2012;37:130–135.

Lee Y.S., Nam K.-H., Chung W.Y. Postoperative complications of thyroid cancer in a single center experience. J. Korean Med. Sci. 2010;25:541–545.

Morrissey A.T., Chau J., Yunker W.K. Comparison of drain versus no drain thyroidectomy: randomized prospective clinical trial. J. Otolaryngol. 2008;37:43–47.

Calo PG, Pisano G, Piga G et al (2010) Postoperative hematomas after thyroid surgery. Incidence and risks factors in our experience. Ann ItalChir 81:343–347

Oltmann S, Alhefdhi A, Rajaei M, Schneider D, Sippel R, Chen H (2016) Antiplatelet and anticoagulant medications significantly increase the risk of postoperative hematoma: review of over 4500 thyroid and parathyroid procedures. Ann Surg Oncol 23(9):2874–2882

Kalyoncu D, Go¨nu¨llu¨ D, Gedik ML, Er M, Kurog˘lu E, I˙g˘dem AA, Koksoy FN (2013) Analysis of the factors that have an effect on hypocalcemia following thyroidectomy. Turk J Surg 29:171–176

Raffaelli M, De Crea C, D’Amato G, Moscato U, Bellantone C, Carrozza C, Lombardi CP (2015) Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery 159:78–85

Harris SC (1992) Thyroid and parathyroid surgical complications. Am J Surg 163:476–478

Proye C, Carnaille B, Maynou C et al (1990) The parathyroid risk in thyroid surgery. Argument against the early postoperative prescription

Lang H, Yih L, Ng K (2012) A prospective evaluation of quick intraoperative parathyroid hormone assay at th time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 36:1300–1306

Ambe P, Bromling S, Knoefel W, Rehders A (2014) Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg 8:45

Soon P, Magarey C, Campbell P, Jalaludin B (2005) Serum intact parathyroid hormone as predictor of hypocalcaemia after total thyroidectomy. ANZ J Surg 75:977–980

Alhefdi A, Mazeh H, Chen H (2013) Role of postoperative vitamin D and/or Calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta analysis. Oncologist 18:533–542


Refbacks

  • There are currently no refbacks.