[Post-thyroidectomy hemorrhage]

The aim of the study was to estimate the prevalence and causes of haemorrhages, that required extemporaneous surgical treatment, after goiter operations, in our own material. Between 1984 and 2000, i.e. during 17 years, 7400 patients were operated in our Clinic due to different kinds of goiter. Haemorrhage during post operative period was presented in 46 (0.62%) patients. There were 37 women and 9 men in the analysed material. The age of patients was between 19 and 77 years, and the average age was 50.6 +/- 15.4. The lowest percentage of this complication was observed after operation of non-toxic goiter (0.39%) and the highest in a group of patients operated due to Graves-Basedow's disease (1.02%). Frequent local symptoms were observed, such as: enlargement of circumference of neck, supple haematoma with dyspnoea, and sometimes swallowing difficulties. A decrease in blood pressure was observed in 5 (10.9%) patients. Low molecular weight heparin prophylaxis was applied in 18 (39.1%) patients and in 2 cases disorders of blood coagulability were observed. The quantity of drainage from the wound was between 30 and 610 ml, with average 249.8 +/- 144.69 ml. Time from main operation termination to revision was 20 to 1440 minutes, with average time 346 +/- 285.66 minutes. The most common cause of post-thyroidectomy haemorrhage was bleeding from the thyroid lobe stump, which presented in 28 (60.9%) patients. The most dangerous haemorrhage, because of its intensity, was the bleeding from the upper thyroid artery (6 patients). During the postoperative period 16 patients (34.8%) required blood transfusions, however massive transfusions (4 and more blood units) were performed only in 4 patients. Early complications included: paralysis of recurrent laryngeal nerve in 6 patients and transient hypocalcaemia in one patient.