Endocrine Abstracts

Introduction: Thyroidectomy is a quite common procedure. Major postoperative complications of total thyroidectomy, including recurrent laryngeal nerve injur and hypocalcemia are not infrequent. The purpose of this study was to evaluate the incidence and risk factors of postoperative complications after total thyroidectomy.

Methods: We retrospectively included patients who underwent total thyroidectomy over a period of 6 years. Hypocalcemia was defined as a blood calcium level that was strictly below 2 mmol/l and considered definitive after more than 6 months of vitamin-calcium treatment. Recurrent nerve palsy that persists beyond 12 months was defined as permanent.

Results: This study included 372 patients (87.4% female), of whom 117 underwent central neck dissection. The mean age was 48 years. Histopathological examination revealed one to two resected parathyroid glands in 63 patients (16.9%). Hypocalcemia was transient in 116 cases (31.2%) and permanent in 22 cases (5.9%). We observed 43 cases of recurrent nerve palsy (11.6%) of which 39 were transient (10.5%) and 4 were definitive (1.1%), 1 case of hematoma (0.3%), 4 cases of cervical abscesses (1.1%), 5 cases of lymphorrhea (1.3%) and 7 cases of keloid scarring (1.9%). On univariate analysis, the risk factors of transient hypocalcemia were parathyroid autotransplantation (P= 0.018), parathyroid gland in the surgical specimen (P= 0.001). Transient and permanent hypocalcemia were significantly associated with longer operative time, central neck dissection and cancer on histopathological examination. Male (P= 0.007), smoking (P= 0.013), and Graves’ disease (P= 0.042) were significantly associated with definitive recurrent nerve palsy. On multivariate analysis, the presence of parathyroid gland in the surgical specimen was the risk factor for transient hypocalcemia (OR: 2.09) and Graves’ disease for definitive recurrent nerve palsy(OR: 670).

Conclusion: Complications of total thyroidectomy occur in specific circumstances. Involuntary parathyroidectomy and Graves’ disease were independent risk factors for transient hypocalcemia and definitive recurrent nerve palsy respectively. Given these risk factors, preventive procedures can be considered to minimize the morbidity of this surgery.