Endocrine Abstracts

Background: Surgery has a significant role in the management of benign thyroid disease, necessitating pre-operative evaluation and appreciation of possible complications. These include hypoparathyroidism and hypothyroidism. We compared outcomes of our benign thyroid disease patients requiring surgery to national standards set by the British Thyroid Association.

Method: Outcomes for patients operated between December 2010 and December 2012 with benign disease within our Trust were audited.

Results: Sixty-one patients underwent thyroid surgery (62% were physician referrals) including 54 females and seven males (mean ages 49 and 55 years respectively). Procedures performed included hemi-thyroidectomy (31/61), total thyroidectomy (13/61), subtotal thyroidectomy (15/61), completion thyroidectomy (1/61) and thyroglossal cyst excision (1/61). In the majority, surgery was indicated for clinical reasons (51/61), including multi-nodular goitre (33/61), Graves’ disease (12/61), toxic nodule (3/61) and Thy3a/f disease (3/61). Pre-operative imaging was arranged in 55/61 patients. Thyroid status at the time of surgery, included euthyroid (42/61), hyperthyroid (17/61) and hypothyroid (2/61). Operative histology confirmed benign disease in 60/61 patients and one incidental focus of papillary carcinoma in the remaining patient. No early complications (within 6 post-operative months) were experienced in 35/61 patients. Early complications included hypocalcaemia (13/61), haematoma formation (4/61 with three patients requiring revision operations), wound infection (2/61), recurrent laryngeal nerve injury (7/61 although not persisting after 6 months) and hypothyroidism (12/61). Late hypocalcaemia was present in 9/61 patients, requiring treatment with calcium alone (1/9) or combined with hydroxylated vitamin D derivatives (8/9). All patients hyperthyroid pre-operatively were cured.

Conclusion: Compared with the national average, our early hypocalcaemia rate is less (21.3 vs 30%) but our late hypocalcaemia rate is greater (14.8 vs 10%). Endocrinologists and thyroid surgeons at our trust will collaborate to form a standardised care pathway for all thyroid surgery patients, to include referral to endocrinology for all patients with abnormal pre-operative thyroid function.