Management of complications after thyroid surgery

Abstract

The evolution of thyroid surgery has decreased the incidence of complications significantly. Experienced endocrine surgeons report less than 1% of complications. However, laryngeal nerve injury and hypocalcaemia still occur. Less common complications of thyroidectomy include postoperative bleeding, major thoracic duct injury, and even more rarely tracheal injury and oesophageal injury. In cases of postoperative voice change or hoarseness, the patient should be evaluated with direct laryngoscopy to define the extent of injury and the course of treatment. Steroids may be used. The patient should be followed up until complete resolution of nerve palsy. If the laryngeal nerve injury is considered permanent, operative treatment may be considered by referral centres with expertise. Swallowing studies and voice therapy should also be initiated. Post-thyroidectomy bleeding may be life-threatening and requires an emergency reoperation to decompress the upper airway. Injury of the major thoracic duct may be managed with either conservative or operative treatment based on the amount of daily lymphorrhea. Injury of the trachea and/or oesophagus usually requires surgical repair. The above complications require an immediate and stepwise therapeutic approach from the vigilant surgeon. Although the prevention of those complications remains the first goal of the surgeon, if such complications are encountered, the surgeon should implement the most appropriate intervention according to the above recommended management guidelines.