Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients.
ABSTRACT During recent years, more radical surgery for thyroid disease, i.e., total instead of subtotal resection, has been evident. Results following this strategy on national levels are scarce.
From 2004 to 2006, 26 Scandinavian Departments registered 3,660 thyroid operations in a database. Risk factors for complications were analyzed with multiple logistic regression.
After thyroidectomy, re-bleeding occurred in 2.1% and was associated with older age (OR 1.04; p < 0.0001) and male gender (OR 1.90; p = 0.014). Postoperative infection occurred in 1.6% and associated with lymph node operation (OR 8.18; p < 0.0001). Postoperative unilateral paresis of the recurrent laryngeal nerve was diagnosed 3.9% and bilateral paresis in 0.2%. Unilateral paresis was associated with older age, intrathoracic goiter, thyreotoxicosis, and if routine laryngoscopy was practiced (OR 1.92; p = 0.0002). After 6 months, the incidence of nerve paresis was 0.97%. After bilateral thyroid surgery (n = 1,648), hypocalcaemia treated with vitamin D analogue occurred in 9.9% of the patients at the first follow-up and in 4.4% after 6 months.
Complications to thyroid surgery are not uncommon. The high frequency of hypocalcaemia treated with vitamin D after 6 months is a cause of concern.
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ABSTRACT: Context: Ultrasound (US)-guided radiofrequency ablation (RFA) of solid thyroid nodules (TNs) is a minimally invasive procedure that may induce a volume reduction of symptomatic solid benign thyroid nodules (TNs). Objective: The aim of the study was to evaluate the effectiveness and safety of RFA in debulking benign TNs. Design and Patients: Eighty-four consecutive patients with symptomatic and cytologically benign solid nodules were randomly assigned to either a single RFA session (Group A; n = 42) or follow up (Group B; n = 42) at our centre. Entry criteria were: solid thyroid nodule or predominantly solid (with a fluid component ≤30% of the volume), normal thyroid function, no autoimmunity, no previous thyroid gland treatment. Three subgroups were formed according to baseline volume of nodules: small (≤ 12 mL), medium (from 12 to 30mL), or large (>30mL). Methods: Group A: RFA was performed in a single session with the moving-shot technique. Volume and local symptom changes were evaluated 1 and 6 months after RFA. Results: Group A: Volume decreased from 24.5.5 ± 19.6 to 8.6 ± 9.5 six months after RFA (p = 0.001). The greatest volume reduction was in small nodules. Pressure symptom score improved only in medium and large nodules (p<0.001), whereas cosmetic score improved in all treated patients (p<0.001). The rate of thyroid volumetric reduction (TVR) was not statistically different between solid and predominantly solid nodules. Only one patient experienced permanent right paramedian vocal cord palsy with inspiratory stridor without dysphonia. In Group B, nodule volume remained unchanged while symptom score was worse at six-month evaluation (p=0.01). Conclusions: RFA is effective in reducing thyroid nodule volume. The best reduction rate was observed in small TNs. TVR does not change according to sonographic features. The mean treatment duration was longer in larger TNs.Journal of Clinical Endocrinology & Metabolism 11/2014; 100(2):jc20142186. · 6.31 Impact Factor
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ABSTRACT: The most common complications after thyroidectomy are injuries associated with the recurrent laryngeal nerve and parathyroid gland. Cervical esophagus perforation is an exceptionally rare complication after thyroidectomy; it can usually be resolved by conservative care. Cervical esophageal stenosis secondary to intraoperative esophageal injury during thyroidectomy is much rarer and has not been reported in the literature to date. We report a case of esophageal stenosis following thyroidectomy performed at a peripheral hospital. The patient initially underwent a thyroidectomy for papillary thyroid carcinoma involving the cervical esophagus; esophageal perforation was noted intraoperatively, and closed using three number 4 silk sutures. Cervical esophageal stenosis subsequently developed after conservative care. The patient was successfully treated with cervical esophagectomy and reconstruction using a tubed forearm free flap after a failed attempt at endoscopic recanalization. This case is discussed in conjunction with a review of the literature.World Journal of Surgical Oncology 10/2014; 12(1):308. · 1.20 Impact Factor
- The Laryngoscope 01/2015; · 2.03 Impact Factor