Complications in primary and completed thyroidectomy

To compare the rates of postsurgical complications following a primary and completed thyroidectomy for multinodular goiter (MNG).

A total of 7123 cases of thyroidectomy in two hospitals from 1990 to 2007 (n = 3834 [53.83%] total [TT], n = 2238 [31.42%] subtotal [ST], and n = 1051 [14.75%] hemithyroidectomy [HT]) were studied for complications. The follow-up checked for injury of the laryngeal nerves, hypoparathyroidism, pathology recurrence, and appearance of neoplasm.

Postoperative mean follow-up: 7 years 9 months Primary operation: permanent recurrent laryngeal nerve (RLN) injury was observed in 1.4% in the TT group, 1.2% in the ST, and 0.9% in the HT group (P > 0.1 vs ST and TT). Permanent hypocalcaemia: 3.5% in TT group, 2.5% in the ST, in 1.4% in the HT. Eight hundred and seventy-seven patients suffered recurrence of MNG (n = 482 after ST, n = 395 after HT). Five hundred and sixty-four recurrent cases required a completion thyroidectomy. Reoperations: Permanent RLN injury was observed in 3% in the post-ST group and 2.5% in the post-HT group. Permanent hypocalcemia: 5.9% in the post-ST group and 4% in the post-HT group.

There is no significant difference in complications between a primary TT and ST. The rates of complications after a completed thyroidectomy are significantly higher in comparison with the primary operations. High rates of reoperation in cases of recurrent pathology and incidental carcinoma were reported.