Complications of thyroidectomy

What it is

Thyroidectomy is done for benign and for malignant conditions: thyroid nodules, hyperthyroidism, an obstructive or substernal goiter, differentiated papillary or follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer. In primary thyroid lymphoma the treatment is chemotherapy or radiation, and the role of surgery is limited to obtaining tissue biopsy. Metastases to the thyroid from cancers elsewhere are rare, most commonly from renal cell carcinoma in clinical series and from the lung in autopsy series, and thyroid surgery can give local control when the metastasis is isolated.

Causes and risk

Before surgery, ENT laryngoscopy is done to document vocal cord movement, and the risks are explained to the patient: recurrent laryngeal nerve injury at 1 %, bilateral nerve injury at 1 in 500, post-op hypocalcemia, thyroxine for life, wound infection, keloid formation, paresthesia in the wound area, and the risk of another surgery if only a hemithyroidectomy is done. The recurrent laryngeal nerve is at risk because it lies near the tracheoesophageal groove; hypocalcemia follows accidental removal of a parathyroid gland or devascularization; and a neck hematoma follows vessel injury.