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Maheshwari M, Khan IA. Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review. Cureus 2024; 16:e66551. [PMID: 39258042 PMCID: PMC11383864 DOI: 10.7759/cureus.66551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
Hypoparathyroidism is a common complication following thyroidectomy, resulting in significant disturbances in calcium homeostasis due to low parathyroid hormone (PTH) levels. This comprehensive review examines the risk factors associated with transient and permanent hypoparathyroidism post-thyroidectomy, emphasizing surgical, patient-related, and perioperative factors. Transient hypoparathyroidism, characterized by temporary hypocalcemia resolving within weeks to months, is often managed with short-term calcium and vitamin D supplementation. In contrast, permanent hypoparathyroidism persists beyond six months post-surgery, necessitating lifelong supplementation and potentially PTH replacement therapy. The review delves into the anatomy and physiology of the parathyroid glands, mechanisms leading to hypoparathyroidism, and incidence rates. Surgical factors such as the extent of thyroidectomy, surgeon expertise, and intraoperative parathyroid gland preservation are critical in determining the risk of hypoparathyroidism. Patient factors, including age, sex, pre-existing conditions, and perioperative management, influence outcomes. Diagnostic and monitoring strategies, along with management protocols for both transient and permanent hypoparathyroidism, are discussed. Prevention strategies, emerging research, future surgical techniques, and intraoperative monitoring directions are highlighted to improve clinical outcomes. This review aims to enhance understanding, inform surgical practices, and optimize postoperative care to minimize the incidence and impact of hypoparathyroidism in thyroidectomy patients.
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Affiliation(s)
- Maulik Maheshwari
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Imran Ali Khan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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G/Tsion MT, Berhanu AB, Mitiku MW, Shumargaw AT, Kidane KH. Outcomes and predictors of complications of thyroidectomy in a scarce resource setting: Retrospective cross-sectional study. Am J Otolaryngol 2024; 45:104125. [PMID: 38039910 DOI: 10.1016/j.amjoto.2023.104125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Outcomes 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. OBJECTIVE To evaluate the outcomes and predictors of complications of thyroidectomy among operated patients. METHOD Single 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. RESULT Overall, 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. CONCLUSION The 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.
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Affiliation(s)
- Mulugeta Taeme G/Tsion
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Abel Balcha Berhanu
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mengistu Worku Mitiku
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | | | - Kiflom Hadgu Kidane
- Department of Medicine, Menilik II Medical and Health Science College, Addis Ababa, Ethiopia
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Zhang J, Liu W, Zhang Q, Zhao C, Li J, Li X, Li G, Chen J, Peng D, Wang Y, Yang C. Total thyroidectomy for giant nodular goiter guided by pre-operative 3D computed tomography reconstruction and 3D printing: A case report. Medicine (Baltimore) 2022; 101:e32456. [PMID: 36596049 PMCID: PMC9803474 DOI: 10.1097/md.0000000000032456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nodular goiter is a common clinical problem, and thyroidectomy is preferred in patients with obstructive symptoms. Thyroidectomy is a complex procedure with some common complications. Three-dimensional (3D) computed tomography (CT) reconstruction and 3D printing provide visualized 3D anatomical structure, posing an enormously valuable potential in precise surgery with optimal efficacy and minimum complications. Here, we aimed to perform a precise thyroidectomy guided by this technology. METHODS The patient was an 80-year-old woman with 10 years of goiter, 1 year of labored dyspnea, and a history of thyroid surgery 62 years ago. In addition to ultrasonography examination, CT images were obtained to construct the 3D model to identify the 3D relationship between the lesion and adjacent structures, and a 3D model of the trachea was created and printed using a 3D printer. RESULTS The 3D model clearly presented the diffuse enlargement of the two lobes and isthmus and the compression of the goiter. Under the 3D guidance, the operative resection specimen of the right lobe and isthmus was 12 ´ 7 ´ 5 cm, whereas the left lobe specimen was 12 ´ 9 ´ 6 cm. Nodular goiter and lymphocytic thyroiditis were confirmed by postoperative histopathology. There were no complications after total thyroidectomy except for non-permanent hypocalcemia and hypoparathyroidism. CONCLUSION Our results proved that total thyroidectomy for giant goiter is challenging, and 3D image-guided thyroidectomy facilitates precise and safe resection with fewer complications. 3D CT reconstruction and 3D printing can provide anatomical details and may be considered in thyroidectomy planning for patients with giant goiter.
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Affiliation(s)
- Jun Zhang
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
- * Correspondence: Jun Zhang, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Shenzhen 518067, China (e-mail: )
| | - Wanli Liu
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Qi Zhang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chongru Zhao
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Jie Li
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Xing Li
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Gezi Li
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Jiali Chen
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Dawei Peng
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Yifei Wang
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Chang Yang
- Department of Thyroid and Breast Surgery, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
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Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 2022; 74:1943-1951. [PMID: 36063287 DOI: 10.1007/s13304-022-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
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Wondwosen M, Bekele M, Abebe K, Tantu T, Zewdu D. Factors associated with thyroidectomy complications in resource-limited settings: An observational study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yilmaz F, Bas K, Deniz O, Damar N. Tracheal Cuff Rupture During Conventional Total Thyroidectomy: An Unusual Complication. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03396-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bawa D, Alghamdi A, Albishi H, Al-Tufail N, Sharma SP, Khalifa YM, Khan S, Alhajmohammed MA. Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period. Ann Saudi Med 2021; 41:369-375. [PMID: 34873936 PMCID: PMC8650599 DOI: 10.5144/0256-4947.2021.369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Dauda Bawa
- From the Department of Surgery, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
| | - Amal Alghamdi
- From the Department of Surgery, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
| | - Hanan Albishi
- From the Department of Surgery, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
| | - Nasser Al-Tufail
- From the Department of Surgery, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
| | - Shashi Prabha Sharma
- From the Department of Pathology, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
| | | | - Saleem Khan
- From the Department of Surgery, King Abdullah Hospital, Bisha, Asir, Saudi Arabia
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Van Slycke S, Van Den Heede K, Bruggeman N, Vermeersch H, Brusselaers N. Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients. Int J Surg 2021; 88:105922. [PMID: 33774174 DOI: 10.1016/j.ijsu.2021.105922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/20/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding are the most frequent postoperative complications after thyroid surgery, and therefore often used as quality indicators of thyroid surgery. We aimed to assess postoperative morbidity in a high-volume endocrine surgery unit, and to detect which factors are associated with higher risks. METHODS Prospective surgical cohort in a high-volume tertiary referral centre for endocrine surgery in xxx. The first 1500 patients operated with hemi or total thyroidectomy during 2010-2019 were included. Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and peri-operative characteristics using multivariable logistic regression analyses, expressed as odds ratios and 95% confidence intervals. RESULTS Overall, 1043 patients (69.5%) received a total thyroidectomy and 457 (30.5%) a hemithyroidectomy. Permanent hypocalcaemia occurred in 3.1%, permanent recurrent laryngeal nerve palsy in 1.8% and surgical reintervention for bleeding in 2.6%. Younger age, female sex and cancer were risk factors for permanent hypocalcaemia. No clear risk factors could be identified for permanent nerve palsy. Female sex, high body mass index and heavier thyroids were protective against postoperative bleeding after total thyroidectomy. CONCLUSIONS Surgical experience in endocrine surgery seems beneficial for clinical outcomes and contributes to organizational efficiency. A low complication risk can be obtained by trained high-volume endocrine surgeons, yet the risk is not negligible.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Endocrine Surgery, Hammersmith, 72 Du Cane Road, W12 0HS, London, UK
| | - Niels Bruggeman
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Karolinska Hospital, Solnavägen 9, 17165, Stockholm, Sweden.
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Van Slycke S, Van Den Heede K, Brusselaers N, Vermeersch H. Feasibility of Autofluorescence for Parathyroid Glands During Thyroid Surgery and the Risk of Hypocalcemia: First Results in Belgium and Review of the Literature. Surg Innov 2020; 28:409-418. [PMID: 33372584 DOI: 10.1177/1553350620980263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Post-operative hypocalcemia remains the most frequent complication after total thyroidectomy. Recently, autofluorescence imaging was introduced to detect parathyroid glands early during dissection. Aim. We aimed to check the feasibility of autofluorescence regarding the number of parathyroid glands visualised and the risk of post-operative hypocalcemia. Methods. In a prospectively gathered cohort of patients undergoing thyroid surgery, we describe the risk of hypocalcemia in relation to the number of parathyroid glands visualised during surgery (and the risk reported in the scientific literature) and the feasibility to obtain an autofluorescence of the parathyroid glands. Results. From 2010 to 2019, 1083 patients were referred for total thyroidectomy in our tertiary referral centre for endocrine surgery, of which, 40 consecutive cases were operated using autofluorescence. Among the autofluorescence group, 14 (35.0%) had all 4 parathyroid glands visualised, compared to 147 (14.1%) in the other patients, without differences in the number of parathyroid glands reimplanted. No permanent hypocalcemia occurred in the autofluorescence group and 17.5% temporary hypoparathyroidism, compared to 3.1% and 31.9% among the other patients, and 4% (95% confidence interval [CI] 3-5%) and 19% (95% CI 15-24%) in the literature. Conclusion. Autofluorescence imaging provides reliable real-time visualisation at any point during thyroid surgery and helps to identify the parathyroid glands before detection with the naked eye. To date, it cannot be used as a standard technique and does not replace meticulous dissection. To become a useful adjunct in peroperative parathyroid management, large multicentre studies need to establish a potential clinical benefit of this novel technique.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Department of General Surgery, 81800AZ Damiaan, Gouwelozestraat, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, 74840Onze-Lieve-Vrouw (OLV) Hospital Aalst, Aalst, Belgium.,Department of Endocrine Surgery, 129363Hammersmith Hospital, London, UK
| | - Nele Brusselaers
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, 27106Karolinska Institute, Stockholm, Sweden
| | - Hubert Vermeersch
- Department of Head and Skin, RinggoldID:60200University Hospital Ghent, Ghent, Belgium.,Plastic and Reconstructive Surgery, Department of Human Structure and Repair, 60200University Hospital Ghent, Ghent, Belgium
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Feasibility criteria for total thyroidectomy in outpatient surgery. ANNALES D'ENDOCRINOLOGIE 2019; 80:286-292. [DOI: 10.1016/j.ando.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/06/2019] [Accepted: 04/25/2019] [Indexed: 11/19/2022]
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Chahardahmasumi E, Salehidoost R, Amini M, Aminorroaya A, Rezvanian H, Kachooei A, Iraj B, Nazem M, Kolahdoozan M. Assessment of the Early and Late Complication after Thyroidectomy. Adv Biomed Res 2019; 8:14. [PMID: 30993084 PMCID: PMC6425745 DOI: 10.4103/abr.abr_3_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The complications in thyroid surgery have been reported variable in literature. The aim of this study was to evaluate the early and late (3 months after surgery) complication rates of thyroidectomy in a cohort of patients undergoing thyroid surgery at two hospitals of Isfahan University of Medical Science, Iran. Materials and Methods This study included 204 patients who candidates for thyroidectomy presenting at Medical Educational Centers of Al-Zahra and Kashani hospitals in Isfahan between March 2016 and March 2017. Clinical data are collected for all patients by continuous enrollment. The patients examined before and after thyroid surgery and the findings were recorded. Results The highest prevalence of thyroidectomy was in women (81.9%). The most frequent thyroid surgery was total thyroidectomy and the most common indication for thyroid surgery was suspicious fine-needle aspiration for thyroid malignancy. Hypocalcemia was the most common complication with a frequency of 54.4%. The odds ratios for early complications were 2.375 and 2.542 for intermediate- and low-volume surgeons, respectively, compared to high-volume surgeons. Conclusions According to the results of this study, the high level of surgeon's skill is effective to reduce the likelihood of late and early complications; furthermore, the chance of late complications increases with age.
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Affiliation(s)
| | - Rezvan Salehidoost
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Massoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Rezvanian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Kachooei
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Nazem
- General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Kanat BH, Bozan MB, Emir S, Yazar FM, Erol F, Alataş Ö, Altınsoy HB, Aksu A. A complication of thyroidectomy: Do not forget suture reaction. Turk J Surg 2017; 33:58-61. [PMID: 28740951 DOI: 10.5152/ucd.2017.3182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/04/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we aimed to present patients who have developed suture reaction and were treated in our clinic following thyroidectomy operation. MATERIAL AND METHODS Patients who had been treated for suture reaction following thyroidectomy between January 2012 and December 2014 were retrospectively evaluated. The patients were analyzed in terms of their age, gender, duration of the symptoms, type of previous operation and treatment modality. RESULTS Between January 2012 and December 2014, 559 thyroid/parathyroid operations were performed in our clinic. A total of 12 patients were admitted with suture reaction within this period thus yielding a suture reaction incidence of 2.1%. The mean age of these patients was 42±7.65 years, 75% of them were female while 25% of them were male. The types of previous operations were bilateral total thyroidectomy in 83.3%, lobectomy in 8.3% and near total thyroidectomy in 8.3% of the patients. The mean symptom duration was 7.2±4.3 (2-16) months. Two patients (16.7%) underwent a second surgical operation for suture reaction, while 10 patients (83.3%) were treated conservatively. None of the patients developed complications. CONCLUSION One of the most common complications that develop after thyroidectomy is bleeding. Ligation must be performed in order to prevent this complication. As it is known, surgical ligation with sutures may cause tissue reaction. Sutures that are absorbable and have a low risk for reaction formation should be chosen if suturing is preferred.
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Affiliation(s)
- Burhan Hakan Kanat
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Mehmet Buğra Bozan
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Seyfi Emir
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Fatih Mehmet Yazar
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Fatih Erol
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Özkan Alataş
- Department of Radiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Hasan Baki Altınsoy
- Department of Radiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Ali Aksu
- Department of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
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Hurtado-López LM, Díaz-Hernández PI, Basurto-Kuba E, Zaldívar-Ramírez FR, Pulido-Cejudo A. Efficacy of Intraoperative Neuro-Monitoring to Localize the External Branch of the Superior Laryngeal Nerve. Thyroid 2016; 26:174-8. [PMID: 26560965 DOI: 10.1089/thy.2015.0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study investigated whether visual localization of the external branch of the superior laryngeal nerve (EBSLN) coincides with its localization via intraoperative neuro-monitoring (IONM) during thyroidectomy and whether its use influences the frequency of injuries. METHODS A prospective, comparative, cross-sectional, observational study was performed in 240 superior thyroid poles. The metrics were visual identification of the EBSLN and its corroboration with IONM. The frequency of EBSLN injuries was also determined. Statistical analysis was achieved via kappa and chi-square tests, as well as odds ratios (OR). RESULTS Of the 240 superior thyroid poles, IONM identified 234 (97.5%) EBSLN, whereas 190 (79.1%) were identified visually: OR = 10.35 [CI 4.37-24.65] p < 0.0001. Of the 190 EBSLN identified visually, 150 were confirmed through IONM. Indeed, their structure corresponded to an EBSLN to yield a kappa with a linear weighting value of 0.362. The standard error was 0.0467 [CI 0.2686-0.4554], indicating a fair agreement between the visual and IONM classification. CONCLUSION IONM identified 97.5% of EBSLN cases. It was higher than the visual identification. There were no injuries to EBSLN identified through IONM.
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Affiliation(s)
| | | | - Erich Basurto-Kuba
- Thyroid Clinic, General Surgery Service, General Hospital of Mexico , Mexico City, Mexico
| | | | - Abraham Pulido-Cejudo
- Thyroid Clinic, General Surgery Service, General Hospital of Mexico , Mexico City, Mexico
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