Endocrine Abstracts

Introduction: major complications of thyroid surgery include; injury to the recurrent laryngeal nerve that can cause dysphonia and acute respiratory distress, postsurgical hematoma, infection and hypoparathyroidism, which can be transient or permanent.

Objective: to analyze the complications observed after performing thyroid surgery with different pre-surgical diagnoses in our center.

Methods: retrospective descriptive study of thyroidectomies performed during the years 2018 to 2021 by the General surgery, Otolaryngology, Thoracic surgery and Pediatric surgery services of the Gregorio Marañón Hospital in Madrid, Spain.

Results: A total of 624 patients were included, 69.6% of whom were women. The presurgical diagnoses were: multinodular goiter (36.1%), hyperparathyroidism (14.6%), nodule suspicious for malignancy (4.5%), thyroid cancer (24.8%), Graves-Basedow disease (7.1%) and others (5%). 47 patients (7.5%) underwent reoperation. Total thyroidectomy was performed in 56.4%, followed by right hemithyroidectomy in 19.2%, left hemithyroidectomy in 11.5%, parathyroidectomy in 2.4% and others in 1.4%. 80.3% of the surgeries were performed by General surgery, 5.6% by Otolaryngology, 2.4% by Thoracic Surgery, 3% by other services. Lymphadenectomy was performed in 18.3%. Of the patients who underwent surgery, 6 of them (1%) presented pre-surgical hypoparathyroidism. After surgery, 21.5% of patients had transient hypoparathyroidism, which was the most frequently observed complication and 5.8% had permanent hypoparathyroidism. In more than 60% of patients both recurrent laryngeal nerves were visualized and intraoperative neuromonitoring was performed. In 61%, intraoperative parathyroid hormone (PTH) drop was calculated in addition to pre- and postoperative PTH. In relation to recurrent paralysis, it was transient in 7% and permanent in 3.4%. 26 cases (4.2%) of postsurgical hematoma and 6 cases (1%) of infection were documented.

Conclusion: the most common postsurgical complication was transient hypoparathyroidism (21.5%) followed by transient recurrent paralysis (7%). Intraoperative determination of PTH is a predictive factor for the development of hypoparathyroidism. Neuromonitoring during surgery helps to preserve recurrent nerves. The development of postsurgical complications is greater in patients undergoing surgery for thyroid cancer, in total thyroidectomy and to a large extent depends on the experience of the center and the surgeons.