• International Association of Endocrine Surgeons-Manuscripts Presented at the 31st Congress of the International Socity of Surgery
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Total thyroidectomy: Complications and technique

Abstract

During the 27-year period from 1957 to 1984, four hundred thirty patients underwent total thyroidectomies for malignant or benign disease of the thyroid gland at our institutions. Thyroid cancer was found in 83.4% of cases, and 47.2% of these had concomitant lymph node dissections. Transient recurrent laryngeal nerve injury occurred in 6.2% of the entire series. Permanent unilateral vocal cord paralysis occurred in 2.5% of the patients operated on, although only 1 patient (0.45%) sustained this complication in the past 14 years. No patient had permanent bilateral vocal cord paralysis. Transient hypoparathyroidism was seen in 16.8% of patients with permanent hypoparathyroidism occurring in 4.0%. The incidence of permanent hypoparathyroidism fell to 2.7% during the past 14 years and was directly related to the extent of thyroid cancer found at operation. Postoperative complications decrease with the experience of the surgeon and increase with reoperations and extensive disease. Total thyroidectomy continues to be our treatment of choice for thyroid cancer.

Résumé

Au cours d'une période de 27 ans de 1957 à 1984, quatre cent trente patients ont subi une thyroïdectomie totale dans notre établissement pour des lésions bénignes ou malignes du corps thyroïdien. Dans 83.4% des cas il s'agit d'un carcinome thyroïdien, nécessitant chez 47.2% d'entre eux un curage ganglionnaire associé. On observe une atteinte transitoire du nerf récurrent laryngé dans 6.2% des cas sur la totalité de la série. Une paralysie permanente unilatérale des cordes vocales survient chez 2.5% des patients opérés, alors que durant les 14 dernières années un seul patient présente cette complication. Aucun des cas de paralysie bilatérale permanente des cordes vocales n'est observé. Une hypoparathyroïdie transitoire est constatée chez 16.8% des patients avec hypoparathyroïdie définitive dans 4.0% des cas. L'incidence de l'hypoparathyroïdisme définitif tombe à 2.7% au cours des 14 dernières années et est directement liée à l'extension du cancer thyroïdien constaté lors de l'intervention. Les complications postopératoires diminuent avec l'expérience du chirurgien et augmentent lors des réinterventions et l'extension des lésions. La thyroïdectomie totale demeure pour les auteurs le traitement de choix du cancer thyroïdien.

Resumen

En el lapso de los 27 años entre 1957 y 1984, cuatro cientos treinta pacientes fueron sometidos a tiroidectomía total por enfermedad maligna o benigna de la glándula tiroides en nuestras instituciones. Cáncer tiroideo fue hallado en 83.4% de los casos, y 47.2% de éstos tuvieron disecciones ganglionares concomitantes. Lesión transitoria del nervio recurrente laríngeo ocurrió en el 6.2% de la serie total. Parálisis permanente unilateral de la cuerda vocal ocurrió en 2.5% de los pacientes operados, mientras sólo un paciente (0.45%) presentó esta complicación en los últimos 14 años. Ningún paciente presento parálisis bilateral permanente de las cuerdas vocales. Hipoparatiroidismo transitorio fue observado en 16.8% de los pacientes, y el hipoparatiroidismo permanente ocurrió en el 4.0%. La incidencia de hipoparatiroidismo permanente descendió a 2.7% en los ültimos 14 años y apareció directamente relacionado con la extensión del cancer tiroideo hallada en la operación. Las complicaciones postoperatorias disminuyen en relación a la experiencia del cirujano y se incrementan con las reoperaciones y con la enfermedad muy extensa. La tiroidectomía total continúa siendo nuestra forma preferida de tratamiento para cáncer tiroideo.

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Correspondence to Jay K. Harness M.D..

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Harness, J.K., Fung, L., Thompson, N.W. et al. Total thyroidectomy: Complications and technique. World J. Surg. 10, 781–785 (1986). https://doi.org/10.1007/BF01655238

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Keywords

  • Thyroid Cancer
  • Recurrent Laryngeal Nerve
  • Total Thyroidectomy
  • Hypoparathyroidism
  • Vocal Cord Paralysis