Postoperative Complications of Thyroid and Parathyroid Disease

Nerve Injury ◽

Laryngeal Nerve ◽

Background Information ◽

Endocrine Surgery ◽

Recurrent Laryngeal Nerve Paralysis ◽

Nerve Paralysis ◽

Although thyroid and parathyroid surgery is considered very safe, with rare morbidity and mortality, serious complications can occur. These include bilateral recurrent laryngeal nerve injury, life-threatening hematoma, and severe hypoparathyroidism. Although infrequent, these complications require timely identification and intensive care. Critical care physicians should understand the clinical presentations and management of affected patients. This review provides a critical care–focused review of endocrine surgery complications, including relevant background information, definitions, risk factors, identification, and management. Special clinical situations and treatment considerations are included. Figures show the vocal fold anatomy in recurrent laryngeal nerve paralysis, the regulation of calcium homeostasis, and electrocardiogram changes seen in the setting of severe hypocalcemia. This review contains 3 figures, and 58 references. Key words: hypocalcemia, hypoparathyroidism, neck hematoma, parathyroid, recurrent laryngeal nerve injury, thyroid

Clinical Complications Post Thyroidectomy

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.34 ◽

2020 ◽

Vol 3 (1) ◽

pp. 159-162

Author(s):

Syed Abdul Hakeem

Keyword(s):

Nerve Injury ◽

Superior Laryngeal Nerve ◽

Laryngeal Nerve ◽

General Surgeon ◽

Recurrent Laryngeal Nerve Paralysis ◽

Metabolic Disturbances ◽

Nerve Paralysis ◽

Background: One of the most commonly conducted operations by a general surgeon are thyroid surgeries. Many complications of thyroid operation are linked to metabolic disturbances or a recurrent laryngeal nerve injury. Superior laryngeal nerve injury, inflammation, weakness of airways and bleeding are other risks. Subjects and Methods: This randomized retrospective sample consists of 50 successive patients who undergo various thyroidectomy procedures and who meet the inclusion criteria after having been introduced to OPD. Results: Post-operative complications following thyroidectomy was seen in 30% of the patients with Hypocalcemia being one of the most prevalent complications postoperatively observed in 18% of the patients followed by wound infection seen in 6% of the cases studied. The frequency of hematoma at the surgical site was 2%. Recurrent Laryngeal Nerve paralysis seen in 2% of the cases and Seroma formation was reported in one individual constituting 2% of the cases. Conclusion: Effective patient surgical control is important and assists in the early detection and treatment of such complications.Careful post-operative patient monitoring ensures quick intervention and helps the patient to achieve better results.

Recurrent Laryngeal Nerve Paralysis and Hypocalcemia in Superior to Inferior Compared to Inferior to Superior Dissection Approaches in Thyroidectomy

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v33i2.267 ◽

2018 ◽

Vol 33 (2) ◽

pp. 24-27

Author(s):

Randel D. Yu

Keyword(s):

Total Thyroidectomy ◽

Nerve Injury ◽

Laryngeal Nerve ◽

Government Hospital ◽

Nerve Paralysis ◽

Significant Difference ◽

Laryngeal Nerve Injury ◽

Superior Approach

Objective: To compare the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve in a tertiary government hospital between January 2012 to December 2016. Methods Design: Retrospective Cohort Study Setting: Tertiary Government Hospital Patients: Records of two hundred forty-one (241) adult patients who underwent surgery for thyroid diseases in the department of Otorhinolaryngology – Head and Neck Surgery between January 2012 and December 2016 were evaluated. Records of patients with postoperative hoarseness after total thyroidectomy or lobectomy with isthmusectomy and hypocalcemia after total thyroidectomy were reviewed, and operative techniques analyzed for the approaches to recurrent laryngeal nerve identification. Results: Records of 119 patients (aged 20-73; median 41-years-old) meeting inclusion and exclusion criteria were analyzed. Of 57 thyroidectomies using a superior-inferior approach, 42 were bilateral, totaling 99; of 62 using an inferior-superior approach, 40 were bilateral, totaling 102. There was a higher incidence of post-operative complications among those who underwent inferior-superior dissection than those who underwent superior-inferior dissection. Chi square test showed the former approach (versus the latter) had 4.86 times the relative risk (RR) of permanent RLN injury (1.9%, 0.0475 to 5.5914, p=.3058), 1.62 times the RR of transient RLN injury (5%, 0.3971 to 6.5889, p=.5021), 1.92 times the RR of permanent hypocalcemia (1.9%, 0.0.1806 to 21.2838, p=.5910), and 2.06 times the RR of transient hypocalcemia (17%, 0.9055 to 4.4333, P=.0738). However, there was no significant difference between the two approaches with regard to hoarseness (independent t test, t value 0.90; p = .367) or hypocalcemia (t=0.428; p= .796). Conclusion: There is no significant difference in the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve. Intraoperatively, surgeons may shift from one approach to the other as needed, and we recommend that they be well versed in both approaches and fully knowledgeable of the various anatomical courses of the recurrent laryngeal nerve and locations of parathyroid gland. Keywords: recurrent laryngeal nerve injuries, thyroid neoplasms, thyroidectomy, vocal cord paralysis, hypoparathyroidism, hypocalcemia

Faculty Opinions recommendation of Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4517960.4376061 ◽

2010 ◽

Author(s):

Gerhard Friedrich ◽

Georg Hammer

Keyword(s):

Nerve Injury ◽

Thyroid Surgery ◽

Laryngeal Nerve ◽

Proper Timing ◽

Recurrent laryngeal nerve injury in thyroid surgery: a review

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2012.06247.x ◽

2012 ◽

Vol 83 (1-2) ◽

pp. 15-21 ◽

Cited By ~ 89

Author(s):

Nathan James Hayward ◽

Simon Grodski ◽

Meei Yeung ◽

William R. Johnson ◽

Jonathan Serpell

Keyword(s):

Nerve Injury ◽

Thyroid Surgery ◽

Laryngeal Nerve ◽

Observations of recurrent laryngeal nerve injury and recovery using a rat model

The Laryngoscope ◽

10.1002/lary.20293 ◽

2009 ◽

Vol 119 (8) ◽

pp. 1644-1651 ◽

Cited By ~ 28

Author(s):

Belachew Tessema ◽

Rick M. Roark ◽

Michael J. Pitman ◽

Philip Weissbrod ◽

Sansar Sharma ◽

...

Keyword(s):

Nerve Injury ◽

Rat Model ◽

Laryngeal Nerve ◽

A current view on recurrent laryngeal nerve injury in total thyroidectomy

Medicina Moderna - Modern Medicine ◽

10.31689/rmm.2021.28.1.7 ◽

2021 ◽

Vol 28 (1) ◽

pp. 7-12

Author(s):

Lucian ALECU ◽

◽

Iulian SLAVU ◽

Adrian TULIN ◽

Vlad BRAGA ◽

...

Keyword(s):

Total Thyroidectomy ◽

Nerve Injury ◽

Unintentional Injury ◽

Laryngeal Nerve ◽

Current View ◽

Pubmed Database ◽

Laryngeal Nerve Injury ◽

The Moment

Introduction: Recurrent laryngeal nerve damage during total thyroidectomy was, is, and probably will be in the near future the Achilles’ heel of total thyroidectomy. Material and method: To perform the research we used the PubMed database. The questions were conceived to respect the PICOS guidelines. The PRISMA checklist was used to filter the results. The search was structured following the words: „recurrent laryngeal nerve injury” AND „total thyroidectomy”. Results: A total of 60 papers were identified. We excluded 12 papers as they were duplicates. From the 48 papers left, another 4 could not be obtained. Another 3 papers from the 44 left were excluded due to the fact they were not written in English. One paper was excluded as the subject did not follow our research purpose. 40 papers were left for analysis and discussion. Conclusion: To prevent recurrent laryngeal nerve lesions, at the moment in the literature there is no consensus. Unintentional injury to the recurrent laryngeal nerve is predictable but not an avertible situation thus bilateral lesions still represent a dramatic situation across the world for the patients and the operating surgeon.