Langenbeck's Archives of Surgery

, Volume 391, Issue 3, pp 169–173 | Cite as

Thyroid surgery: postoperative hematoma—prevention and treatment

  • Jane Harding
  • Frederic Sebag
  • Mauricio Sierra
  • F. Fausto Palazzo
  • Jean-François HenryEmail author
Current Concepts in Endocrine Surgery


Background and aims

Postoperative haematoma formation is a fortunately rare but potentially life-threatening complication of thyroid surgery. This paper aims to identify potential aetiological factors, describe surgical techniques and newer haemostatic agents that may be used to minimise the risk of haematoma formation and propose surgical strategies to deal with haematoma formation.

Materials and methods

An extensive literature search as well as own considerable experience in a tertiary referral centre endocrine surgical unit was drawn upon to review this topic.


Postoperative haematoma may have a multifactorial aetiology. Numerous manoeuvres and surgical haemostatic agents may be employed to minimise the risk of haematoma formation but are no substitute for meticulous haemostasis. In the event of haematoma formation, early surgical re-intervention is strongly advocated with due care given to at risk structures.


Thyroidectomy Haematoma Complication 



J. H. acknowledges the support of the Goddard Sapin-Jaloustre Scholarship Trust.


  1. 1.
    Ardito G, Revelli L, Guidi ML, Murazio M, Lucci C, Modugno P, Di Giovanni V (1999) Drainage in thyroid surgery. Ann Ital Chir 70(4):511–517PubMedGoogle Scholar
  2. 2.
    Frick T, Largiader F (1991) Perioperative complications in thyroid gland surgery. Langenbecks Arch Chir 376(5):291–294CrossRefPubMedGoogle Scholar
  3. 3.
    Hurtado-Lopez L, Zaldivar-Ramirez F, Kuba E; Cejudo A, Flores J, Solis O, Castillo C (2002) Causes for early re-intervention after thyroidectomy. Med Sci Monit 8(4):247–250Google Scholar
  4. 4.
    Shaha A, Jaffe B (1994) Practical management of post-thyroidectomy hematoma. J Surg Oncol 57(4):235–238PubMedCrossRefGoogle Scholar
  5. 5.
    Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck C, Farley DR (2001) Re-exploration for symptomatic hematomas after cervical exploration. Surgery 130(6):914–920CrossRefPubMedGoogle Scholar
  6. 6.
    Chichon S, Anielski R, Orlicki P, Krzesiwo-Stempak K (2002) Post-thyroidectomy haemorrhage. Przegl Lek 59:489–492PubMedGoogle Scholar
  7. 7.
    Palestini N, Tulletti V, Cestino L, Durando R, Freddi M, Sisti G, Robecchi A (2005) Post-thyroidectomy cervical haematoma. Minerva Chir 60(1):37–46PubMedGoogle Scholar
  8. 8.
    Bergmaschi R, Becourarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176(1):71–75CrossRefPubMedGoogle Scholar
  9. 9.
    Woodcock JP, Owen GM, Shedden EJ, Hodgson KJ, McGregor A, Srivastava A (1985) Duplex scanning of the thyroid. Ultrasound Med Biol 11:659–663CrossRefPubMedGoogle Scholar
  10. 10.
    Chang DC, Wheeler MH, Woodcock JP, Curley I, Lazarus JR, Fung H, John R, Hall R, McGregor AM (1987) The effect of preoperative Lugol’s iodine on thyroid blood flow in patients with Graves’ hyperthyroidism. Surgery 102(6):1055–1061PubMedGoogle Scholar
  11. 11.
    Ansaldo G, Pretolesi F, Varaldo E, Meola C, Minuto M, Borgonovo G, Derchi L, Torre G (2000) Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goitre. J Am Coll Surg 191(6):607–612CrossRefPubMedGoogle Scholar
  12. 12.
    Rogula T, Cichon S (2000) Ultrasonographic evaluation of thyroid tissue perfusion in patients with Graves–Basedow disease as preparation for surgery. Folia Med Crac 41:121–129Google Scholar
  13. 13.
    Rodier JF, Janser JC, Petit H, Schneegans O, Ott G, Kaissling A, Grob JC, Velten M (1998) Effect of preoperative administration of Lugol’s solution on thyroid blood flow in hyperthyroidism. Ann Chir 52(3):229–233PubMedGoogle Scholar
  14. 14.
    Goudet P, Ragois P, Guergah M, Cougard P (1996) Specific morbidity of substernal goitres. A comparative study with a matched series of cervical goitres. Ann Chir 50(10):913–917PubMedGoogle Scholar
  15. 15.
    Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A, du Pasquier L, Chigot JP (1999) Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery 126(3):479–483PubMedGoogle Scholar
  16. 16.
    Cougard P, Osmali L, Esquis P, Ognois P (2005) Endoscopic thyroidectomy—a preliminary report including 40 patients. Ann Chir 130(2):81–85CrossRefPubMedGoogle Scholar
  17. 17.
    Miccoli P, Minuto MN, Barellini L, Galleri D, Massi M, D’Agostino J, Materazzi G, Berti P (2004) Minimally invasive video-assisted thyroidectomy—techniques and results over 4 years of experience. Ann Ital Chir 75(1):47–51PubMedGoogle Scholar
  18. 18.
    Gagner M, Inabnet BW 3rd, Biertho L (2003) Endoscopic thyroidectomy for solitary nodules. Ann Chir 128(10):696–701CrossRefPubMedGoogle Scholar
  19. 19.
    Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi P, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentre study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276CrossRefPubMedGoogle Scholar
  20. 20.
    Farrar WB (1983) Complications of thyroidectomy. Surg Clin North Am 63(6):1313–1353PubMedGoogle Scholar
  21. 21.
    Defechereux T, Hamoir E, Nguyen D, Meurisse M (1997) Drainage in thyroid surgery. Is it always a must? Ann Chir 51(6):647–652PubMedGoogle Scholar
  22. 22.
    Daou R (1997) Thyroidectomy without drainage. Chirurgie 122(7):408–410PubMedGoogle Scholar
  23. 23.
    Khanna J, Mohil RS, Chintamani, Bhatnagar D, Mittal MK, Sahoo M, Mehrotra M (2005) Is the routine drainage after surgery for thyroid necessary? A prospective randomized clinical study. BMC Surg 19;5(1):11CrossRefGoogle Scholar
  24. 24.
    Schoretsanitis G, Melissas J, Sanidas E, Christodoulakis M, Vlachonikolis JG, Tsiftsis DD (1998) Does draining the neck affect morbidity following thyroid surgery? Am Surg 64(8):778–780PubMedGoogle Scholar
  25. 25.
    Hurtado-Lopez LM, Lopez-Romero S, Rizzo-Fuentes C, Zaldivar-Ramirez FR, Cervantes-Sanchez C (2001) Selective use of drains in thyroid surgery. Head Neck 23(3):189–193CrossRefPubMedGoogle Scholar
  26. 26.
    Tubergen D, Moning E, Richter A, Lorenz D (2001) Assessment of drain insertion in thyroid surgery. Zentralbl Chir 126(12):960–963CrossRefPubMedGoogle Scholar
  27. 27.
    Shen WT, Baumbusch MA, Kebebew E, Duh QY (2005) Use of the electrothermal vessel sealing system versus standard vessel ligation in thyroidectomy. Asian J Surg 28(2):86–89PubMedCrossRefGoogle Scholar
  28. 28.
    Siperstein AE, Berber E, Morkoyun E (2002) The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery. Arch Surg 137(2):137–142CrossRefPubMedGoogle Scholar
  29. 29.
    Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12(6):876–878CrossRefPubMedGoogle Scholar
  30. 30.
    Dubuc-Lissoir J (2003) Use of a new energy-based vessel ligation device during laparoscopic gynecologic oncologic surgery. Surg Endosc 17(3):466–468CrossRefPubMedGoogle Scholar
  31. 31.
    Luciani N, Anselmi A, Gaudino M, Nasso G, Glieca F, Martinelli L, Santarelli F, Perisano M, Possati G (2005) Harmonic scalpel reduces bleeding and postoperative complications in redo cardiac surgery. Ann Thorac Surg 80(3):934–938CrossRefPubMedGoogle Scholar
  32. 32.
    Agarwal A, Mishra SK (1997) Post-thyroidectomy haemorrhage: an analysis of critical factors in successful management. J Indian Med Assoc 95(7):418–419, 433PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Jane Harding
    • 1
  • Frederic Sebag
    • 1
  • Mauricio Sierra
    • 1
  • F. Fausto Palazzo
    • 1
  • Jean-François Henry
    • 1
    Email author
  1. 1.Department of General and Endocrine SurgeryHôpital de la TimoneMarseilleFrance

Personalised recommendations