Post-thyroidectomy haemorrhage: an analysis of critical factors in successful management

Haemorrhage following thyroidectomy is a well known complication and early intervention is advocated to avoid fatality. Traditionally more emphasis has been given to the amount of drainage, increasing size of the swelling and obvious signs of respiratory obstruction as indications of re-exploration leading to delay, and subtle features of hypoxia like tachycardia, sweating, irritability and confusion resulting from upper airway oedema are usually ignored. The authors described their experience of post-thyroidectomy haemorrhage in 396 thyroidectomies performed during a 6-year period (1989-1995) for various thyroid disorders. All these patients were detected early in the postoperative course based on subtle signs of hypoxia and re-explored. There were 10 cases of post-thyroidectomy haemorrhage and they were successfully managed early in the postoperative period with excellent outcome. Close postoperative monitoring for features of hypoxia rather than external evidence of haemorrhage is the key factor in early detection and successful management of such a fatal complication.