Surgical Complications After Thyroid Surgery: A 10-Year Experience at Jeddah, Saudi Arabia

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

PURPOSE

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSION

Although the number of thyroid surgeries has recently increased, the incidence of post-thyroidectomy hypocalcemia and bleeding did not significantly increase.

Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience

Introduction

Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland.

Aim

The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland.

Methods

The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland.

Results

A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer.

Conclusions

Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.

Diagnosis and treatment of HS after endoscopic thyroid surgery: case report and brief literature review

Background

Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature.

Case report

During a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner's syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved.

Conclusion

Horner's syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.

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.

Recurrent laryngeal nerve injury after thyroidectomy: A national study from Saudi Arabia

OBJECTIVES

To determine the incidence and possible risk factors of recurrent laryngeal nerve injury, to provide a relevant literature review of studies from other centers in Saudi Arabia, and to present basic statistical data for future studies in our local community.

METHODS

A retrospective study enrolled patients who were surgically treated for thyroid disease between January 2015 and December 2021. For concerns during the procedure, direct laryngoscopy was carried out before extubation to assess the vocal cords. Similarly, indirect laryngoscopy was carried out for patients who developed postoperative voice changes. All patients were evaluated clinically 2-3 weeks after surgery. Nerve monitors were not used in either case.

RESULTS

The study examined 437 participants: 361 (82.6%) female and 76 (17.4%) male individuals. The incidence of recurrent laryngeal nerve injury was 1.1%. The demographic characteristics, pathology (benign vs. malignant), and extent of thyroidectomy were not significantly associated with the risk of recurrent laryngeal nerve injury.

CONCLUSION

A recurrent laryngeal nerve injury is a serious complication, and further studies are required to determine the safest techniques for thyroidectomy. However, centralization of thyroid surgery in high-volume centers might reduce this risk.

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.

Post-Thyroidectomy Complications and Risk Factors in Tabuk, Saudi Arabia: A Retrospective Cohort Study

Background Thyroid surgery is one of the most commonly performed procedures internationally. There were no studies conducted in Tabuk, Saudi Arabia, on post-thyroidectomy complications and their risk factors. Objective The aim of this study was to assess post-thyroidectomy complications and determine the risk factors of such complications. Methods This retrospective study included all cases that underwent thyroidectomy at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia, from January 2012 to December 2017. Patients with preoperative hypoparathyroidism, chronic kidney disease, or history of dysphonia were excluded. Data were collected from medical records. Results The study showed 182 patients who underwent thyroidectomy operation between January 2012 and December 2017. Temporary hypocalcemia was developed in 116 patients (63.7%) while it persisted in three (1.6%). Change of voice was reported in five patients (2.7%) while two (1.1%) lost a high-pitched voice. Seroma, hematoma, and tracheal injury were documented in 1.6%, 1.1%, and 0.5%, respectively. Multivariate analysis showed that total thyroidectomy was the most significant (four times) risk factor for the development of hypocalcemia as compared to other surgical procedures. Conclusion Hypocalcemia was the most frequent post-thyroidectomy complication, whereas voice changes, seroma, hematoma, and tracheal injury are rare complications. Additionally, total thyroidectomy has the highest risk of postoperative hypocalcemia.