Complications of thyroid surgery

The current study reports complications from thyroidectomy in 253 consecutive patients from 1988 to 1992. There were 10 temporary cases of hypoparathyroidism. After total thyroidectomy, one of 34 patients (3.2%) developed permanent hypoparathyroidism. Complications of recurrent laryngeal nerve (RLN) injury or hypoparathyroidism were no more common following completion thyroidectomy than total thyroidectomy. Unplanned RLN injury was seen in 13 patients of which 7 were permanent (2.1% of 334 nerves at risk). All 13 patients with RLN injury experienced a reduction in speech "loudness", but only 3 reported "hoarseness". The RLN may be injured without serious vocal disability. Eleven of 171 right RLN's at risk were injured as compared to 2 of 163 left RLN's. The volume of thyroid tissue resected was positively associated with RLN injury (p < 0.05) and not hypoparathyroidism. These findings are discussed. Hypoparathyroidism, not "symptomatic" RLN injury, is the most problematic complication impacting on the decision whether or not to perform total or completion thyroidectomy.