[Follow-up of thyroidectomized patients]

The functional recovery of the patient after thyroid surgery is the primary objective but cannot always be achieved as a result of factors relating principally to the nature of the pathology treated and the extent of the thyroidectomy, though problems linked to possible damage to the recurrent nerves and altered calcium metabolism cannot be ignored. The data obtained from a large case series followed up for an appreciable time show that: Postoperative hypothyroidism is difficult to predict and very much depends on the evolution of the residual thyroid pathology. Subclinical and clinical thyroid insufficiency can be identified by correct assessment of TSH, the TRH test and the clinical picture. Substitution therapy presents no problems but should be personalized for each individual case. Injuries to the recurrent nerves constitute a major complication especially in subjects already afflicted by a monolateral lesion, a possibility that should always be investigated before surgery. The correct surgical technique will always expose and/or prepare the nerve along its entire length. Alterations to calcium metabolism are not always attributable to parathyroid lesions and are in fact almost always the expression of a complex acute deficiency picture that can be cured by correct medical treatment. PTH assays are particularly valuable for this purpose. All the above indicates the outstanding importance of follow-up of thyroidectomy patients who are otherwise destined for dysfunctions or pathologies that are not easy to cure.