The relation between the excised thyroid gland weight and postoperative complications in total thyroidectomy patients

The relation between the excised thyroid gland weight and postoperative complications in total thyroidectomy patients

Aim: The purpose of this study was to determine the postoperative complications in total thyroidectomy patients based on theweight of the thyroid gland with retrospective screening.Material and Methods: A total of 263 adult patients, who underwent total thyroidectomy were included. The data automation systemof the hospital and the files of the patients were examined retrospectively.Results: The total complication incidence was 24.3%, and these were determined as hypocalcemia, vocal cord paralyses (VCP), andhemorrhage and seroma at the surgery area. The rate of temporary hypocalcemia and permanent hypocalcemia rate was 20.1%and 1.5% respectively. The temporary VCP rate was 0.3% (n=1), and no permanent VCP was observed in the patients. The medianthyroid weight was measured as 50 gr in patients without postoperative hypocalcemia, and as 40 g in the patients with hypocalcemia(p=0.283). There was no significant relation between the variability in the weight of the thyroid and postoperative hypocalcemia.However, the cervical lymph node dissection (LND) (p=0.006) and cervical dissection site (p=0.031) were significant in terms ofpostoperative complication development. In the multivariate analyses, it was found that female gender and LND were independentrisk factors in the development of postoperative complications.Conclusion: It was determined that cervical LND and female gender were independent risk factors. Consistent with the literaturefindings, no significant results were found in the risk factors like heavy thyroid gland, presence of thyroid operation history, malignantthyroid pathology, retrosternal localization of the thyroid tissue, and hyperthyroidism.

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  • 1. Gough IR, Wilkinson D. Total thyroidectomy for management of thyroid disease. World J Surg 2000;24:962-5.
  • 2. Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128:389-92.
  • 3. Caulley L, Johnson-Obaseki S, Luo L, et al. Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Med (Baltimore) 2017;96:e5752.
  • 4. Moulton-Barrett R, Crumley R, Jalilie S, et al. Complications of thyroid surgery. Int Surg 1997;82:63-6.
  • 5. R Fernando, PC Chandrasinghe, M Bandara, et al. Hypocalcemia and hoarseness following total thyroidectomy for benign disease relationship of ıncidence to the size of the gland, WJOES, January-April 2011;3:7-9
  • 6. McHenry CR, Piotrowski JJ. Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. Am Surg 1994;60:586-91.
  • 7. Zambudio AR, Rodríguez J, Riquelme J, et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240:18-25.
  • 8. Karabeyoglu M, Unal B, Dirican A, et al. The relation between preoperative ultrasonographic thyroid volume analysis and thyroidectomy complications. Endocr Regul. 2009;43:83-7.
  • 9. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012;22:911-7.
  • 10. Pankow BG, Michalak J, McGee MK. Adult human thyroid weight. Health Phys. 1985;49:1097-103.
  • 11. Herranz González-Botas J, Lourido Piedrahita D. Hypocalcaemia after total thyroidectomy: incidence, control and treatment. Acta Otorrinolaringol Esp. 2013;64:102-7.
  • 12. McManus C, Luo J, Sippel R, Chen H. Is thyroidectomy in patients with Hashimoto thyroiditis more risky? J Surg Res 2012;178:529-32.
  • 13. Edafe O, Antakia R, Laskar N, et al. Authors’ reply: Systematic review and meta-analysis of predictors of postthyroidectomy hypocalcaemia (Br J Surg 2014;101: 307- 320). Br J Surg 2014;101:883-4
  • 14. Ölmez A, Pişkin T, Ünal B, et al, The relation between thyroid gland weight and thyroidectomy complications in the patients with total thyroidectomy, S.B Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 2011;44:95-8.
  • 15. Pfleiderer AG, Ahmad N, Draper MR, et al. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl. 2009;91:140-6.
  • 16. Yamashita H, Murakami T, Noguchi S, et al. Postoperative tetany in Graves disease: important role of vitamin D metabolites. Ann Surg 1999;229:237-45.
  • 17. Moure Rodríguez MD, Luque-Ramírez M, López Gallardo G, et al. [Hungry bone syndrome related to hyperthyroidism]. An Med Interna 2006;23:326-8.
  • 18. Balentine CJ, Sippel RS. Outpatient Thyroidectomy: Is it Safe? Surg Oncol Clin N Am. 2016;25:61-75.
  • 19. Sørensen KR, Klug TE. Routine outpatient thyroid surgery cannot be recommended. Dan Med J 2015;62.
  • 20. Doran HE, England J, Palazzo F. Questionable safety of thyroid surgery with same day discharge. Ann R Coll Surg Engl 2012;94:543-7.
  • 21. Goldfarb M, Perry Z, A Hodin R, Medical and surgical risks in thyroid surgery: lessons from the NSQIP. Ann Surg Oncol. 2011;18:3551-8.
  • 22. Ardito G, Revelli L, Polistena A, et al. Complications of Neck Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity. In Vivo 2016;30:303-8.
  • 23. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 2007;245:604-10.
  • 24. Henry JF, Gramatica L, Denizot A,,,,,,. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 1998383:167-9.
  • 25. Yoo HS, Shin MC, Ji YB, et al. Optimal extent of prophylactic central neck dissection for papillary thyroid carcinoma: Comparison of unilateral versus bilateral central neck dissection. Asian J Surg 2018;41:363-9.
  • 26. Kupferman ME, Patterson DM, Mandel SJet al. Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope 2004;114:403-6.
  • 27. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery 2010;148:398-403.
  • 28. Pieracci FM, Fahey TJ 3rd. Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy. J Am Coll Surg 2007;205:1-7.
  • 29. Testini M, Gurrado A, Avenia N, et al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol 2011;18:2251-9.
  • 30. Testini M, Rosato L, Avenia N, et al. The impact of single parathyroid gland autotransplantation during thyroid surgery on postoperative hypoparathyroidism: a multicenter study. Transplant Proc 2007;39:225-30.
  • 31. Hsu B, Reeve TS, Guinea AI, et al. Recurrent substernal nodular goiter: incidence and management. Surgery 1996;120:1072-5.
  • 32. Saha SP, Rogers AG, Earle GF, et al. Surgical management of intrathoracic goiter. J Ky Med Assoc 1997;95:421-3.
  • 33. Moalem J, Suh I, Duh QY. Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg 2008;32:1301-12.
  • 34. Hermann M, Keminger K, Kober F, et al. [Risk factors in recurrent nerve paralysis: a statistical analysis of 7566 cases of struma surgery]. Chirurg. 199162:182-7.
  • 35. Shindo M, Chheda NN. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481-5.
  • 36. Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, et al. Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg 2007;77:377-80.
  • 37. Runkel N, Riede E, Mann B, et al. Surgical training and vocal cord paralysis in benign thyroid disease. Langenbecks Arch Surg 1998;383:240-2.
  • 38. Suzuki S, Yasunaga H, Matsui H, et al. Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database. Head Neck 2018;40:1548-54.
  • 39. Burkey SH, van Heerden JA, Thompson GB, et al. Reexploration for symptomatic hematomas after cervical exploration. Surgery. 2001;130:914-20.
  • 40. Promberger R, Ott J, Kober F, et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 2012;99:373-9.