Complications in thyroid surgery - retrospective analysis

Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications. But they can have a major impact on the quality of life of patients.

A retrospective analysis of our prospective database of patients after thyroid surgery at the Department of Surgery of the 2nd Faculty of Medicine, Charles University, and Motol University Hospital in Prague operated on in the period 2021-2024 was performed. Patients who underwent total thyroidectomy or lobectomy were included in the study.

Totally 1,559 patients with an average age of 52.1 years were included in the study. There were 1,280 female patients (82.1%). Malignant disease occurred in 375 patients (22.9%). Total thyroidectomy (TTE) was performed in 1,086 patients (69.9%), lobectomy (LE) in 473 patients (30.1%). Total nerves at risk were 2,645. We identified transient unilateral paresis of the recurrent laryngeal nerve (NLR) in a total of 39 patients (1.47%), of which 29 patients after TTE and 10 patients after LE. Permanent unilateral paresis was present in 20 patients (0.75%). Bilateral postoperative NLR paresis occurred in 4 patients (0.36%). Postoperative hypocalcemia occurred in 66 patients after TTE (6.1%). Postoperative hypocalcemia developed in 66% of patients within 24 hrs from surgery and in 96% within 48 hrs. Postoperative bleeding requiring surgical revision occurred in 45 patients (2.8%). The interval from the original operation to the reoperation was 10.4 ± 10.3 hrs, median 6.5 hours.

Surgical therapy of the thyroid gland is associated with a low rate of complications, which, however, can have a major impact on the quality of life of patients. Perfect knowledge of the anatomy of the thyroid gland together with precise surgical technique and consistent hemostasis are the basis of safe thyroid surgery.