Changing trends in thyroidectomy

The objective of this study was to establish the indications, referral trends and demographics for thyroidectomies performed in our institutions over a 13-year period by a single surgeon. We conducted a retrospective chart review of 1003 consecutive thyroidectomies at our institutions during the period 1998 until 2010. The parameters incorporated to this study were age, sex, county, referral source, symptoms, thyroid status, procedure performed, histopathology and post-operative complications. The age range of patients was 4-87 years. There were 777 females and 226 males, with a sex ratio of 3.4:1. The mean age was 51 years. The commonest indications for surgery were a potential or definite neoplastic thyroid mass (781 cases--78%), compressive symptoms (119 cases-- 12%), thyrotoxicosis and endocrine related causes (103 cases--10%). 896 (89.3%) patients were euthyroid, 4 (0.4%) hypothyroid and 103 (10.3%) hyperthyroid. There were 739 partial thyroidectomies and 264 total thyroidectomies. Histopathology results showed that 742 were benign and 261 malignant, of which papillary carcinomas accounted for 75.1%, follicular carcinomas 13.4%, Hurthle cell carcinoma 1.5%, medullary thyroid carcinomas 3 %/, undifferentiated carcinomas 3%, others (lymphoma and squamous cell carcinomas) 4%. Post-operative complications were: Temporary hypocalcaemia--6.4%, Permanent hypocalcemia in--0.8%. Haemorrhage and seroma in 1.5%, unilateral vocal cord paralysis in 1.2%/, post-operative wound infection in 0.3% and pulmonary embolism in 0.01%. There was no mortality. Dublin accounted for 519 (51.7%/) of referrals, 484 (48.3%) was from the rest of the country. General practitioners accounted for 84.8%/ of referrals. Endocrine referrals comprised 9.8%. Other specialities constituted 5.4%. Two significant findings from this study were; firstly, a trend depicting increasing referral rates from the general practitioner and endocrine services. Secondly, low post-operative complication rates that compare favourably to published figures in previous studies from tertiary centres.