Complications after thyroidectomy: narrative review
DOI:
https://doi.org/10.11606/issn.1679-9836.v103i4e-211812Keywords:
Thyroidectomy, Postoperative Complications, Postoperative PeriodAbstract
Introduction: Thyroid disorders are one of the most prevalent endocrine disorders, with thyroidectomy being the most common endocrine surgery for malignant and benign thyroid diseases. Thyroidectomy, despite its effectiveness, is a delicate procedure due to the proximity to important structures, such as the nerves, the lymph nodes and the parathyroid glands. Thus, the incidence of surgical complications is influenced by the extent of the surgery, the thyroid pathology, the anatomical differences, in addition to the surgeon's experience and the association with other procedures. Objective: To carry out a survey regarding the main complications after thyroidectomy and the factors related to the manifestations. Methodology: The literature review was carried out over the months of January and March 2023, through the PubMed, BVS and LILACS databases, using the terms validated by the DeCS “Thyroidectomy”, “Postoperative Complications” and “Postoperative Period”. Results: Eighteen studies were used in the writing of this article after applying the inclusion and exclusion criteria and, subsequently, a table was made with their main findings. Hypocalcemia, hypoparathyroidism and recurrent laryngeal nerve injury are the most common complications after thyroidectomy, the latter being the most serious, with different incidences, causes and prevention. Regarding risk factors, female gender, involuntary parathyroidectomy, parathyroid autograft, surgical extension, and central lymph node dissection were related to a higher incidence of complications. The parathyroid hormone levels were used with predictive value for hypocalcemia and hypoparathyroidism. Conclusion: Thyroidectomy is characterized as a well-established procedure in the medical community, however its approach can bear complications. Studies emphasize hypocalcemia, hypoparathyroidism and recurrent laryngeal nerve injury as the most prevalent, in addition to addressing their causes and risk factors. However, further studies are needed to validate means of prevention to ensure the maintenance of patients' quality of life.
Downloads
References
Akgun IE, Unlu MT, Aygun N, Kostek M, Eray Tufan A, Yanar C, et al. The Reality of Hypoparathyroidism after Thyroidectomy: Which Risk Factors Are Effective? Single Center Study. SiSli Etfal Hastanesi Tip Bulteni. Med Bul Sisli Hosp. 2022;56(2):262-9. Doi: 10.14744/SEMB.2022.24356. https://pubmed.ncbi.nlm.nih.gov/35990295/
Alyahya KA, Alarfaj AA, Alyahya AA, Alnaim AE. Indications and Complications for Surgical Management of Thyroid Diseases: a Single Center Experience. Ann Med Surg. 2022;79. Doi: 10.1016/j.amsu.2022.103980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289332/
Perigli G, Cianchi F, Giudici F, Russo E, Fiorenza G, Petrone L, et al. Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing. J Clin Med. 2021;10(19):4323. Doi: 10.3390/jcm10194323. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509338/
Sonnenberg S, Scheunchen M, Smaxwil CA, Weih H, Vorländer C, Langer P, et al. Short-term Hypocalcemia Prophylaxis with Calcitriol before Thyroidectomy - a Multicenter Randomized Trial. Deut Ärzteblatt Int. 2021;118:799-805. Doi: 10.3238/arztebl.m2021.0351. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884067/
Bawa D, Alghamdi A, Albishi H, Al-Tufail N, Sharma SP, Khalifa YM, et al. Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period. Ann Saudi Med. 2021;41(6):369-75. Doi: 10.5144/0256-4947.2021.369. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650599/
Baud G, Jannin A, Marciniak C, Chevalier B, Do Cao C, Leteurtre E, et al. Impact of Lymph Node Dissection on Postoperative Complications of Total Thyroidectomy in Patients with Thyroid Carcinoma. Cancers. 2022;14(21):5462. Doi: 10.3390/cancers14215462. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9657404/
Abood A, Ovesen T, Rolighed L, Triponez F, Vestergaard P. Hypoparathyroidism following total thyroidectomy: high rates at low-volume, non- parathyroid institution. Front Endocrinol. 2024;15:1330524. Doi: 10.3389/fendo.2024.1330524. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1330524/full
Pasieka JL, Wentworth K, Yeo CT, Cremers S, Dempster D, Fukumoto S, et al. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res. 2022;37(12):2586-601. Doi: 10.1002/jbmr.4714. https://pubmed.ncbi.nlm.nih.gov/36153665/
Arioli EL, Corrêa PHS. Hipocalcemia. Arq Bras Endocrinol Metab [Internet]. 1999;43(6):467-71. Doi: 10.1590/S0004-27301999000600013. https://www.scielo.br/j/abem/a/pPj63ftYs6sBQQFLNHGvMCv/?lang=pt
León-Ballesteros GP, Velázquez-Fernández D, Hernández-Calderón FJ, Bonilla-Ramírez C, Pérez-Soto RH, Pantoja JP, et al. Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands. World J Surg. 2019;43(7):1728-35. Doi: 0.1007/s00268-019-05002-1. https://onlinelibrary.wiley.com/doi/10.1007/s00268-019-04987-z
Yazıcıoğlu MÖ, Yılmaz A, Kocaöz S, Özçağlayan R, Parlak Ö. Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery. Scient Rep. 2021;11(1). Doi: 10.1038/s41598-021-91277-1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178369/
Ataş H, Akkurt G, Saylam B, Tez M. Central Neck Dissection Is an Independent Risk Factor for Incidental Parathyroidectomy. Acta Chirurg Bélg. 2021;121(1):36-41. Doi: 10.1080/00015458.2020.1828677. https://pubmed.ncbi.nlm.nih.gov/32996827/
Lacroix C, Potard G, Thuillier P, Le Pennec R, Prévot J, Roudaut N, et al. Use of the parathyroid hormone assay at H6 post thyroidectomy: an early predictor of hypocalcemia. J Endocrinol Invest. 2021;45(1):1-8. Doi: 10.1007/s40618-021-01601-9. https://pubmed.ncbi.nlm.nih.gov/34216371/
Lenay-Pinon D, Biet-Hornstein A, Strunski V, Page C. The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients. J Laryngol Otol. 2021;135(7):640-3. Doi: 10.1017/S0022215121001493. https://pubmed.ncbi.nlm.nih.gov/34120661/
Ávila KS, Schreider JLS, Rocha LS, Nolasco MS, Mascarenhas AL, Rezende GG, et al. Neuromonitoramento e prevenção de lesão nervosa na tireoidectomia: uma revisão sistemática / Neuromonitoring and neural injury prevention during thyroidectomy: a systematic review. Braz J Hea Rev. [Internet]. 2022;5(3):10875-900. Doi: 10.34119/bjhrv5n3-242 https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/48904
Huang TY, Yu WHV, Chiang FY, Wu CW, Fu SC, Tai AS, et al. Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters. Front Endocrinol. 2021;12:755231. Doi: 10.3389/fendo.2021.755231. https://pubmed.ncbi.nlm.nih.gov/34917026/
Smaxwil C, Aleker M, Altmeier J, Naddaf A, Busch M, Wagner J, et al. Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures. J Clin Med. 2021;10(4):740. Doi: 10.3390/jcm10040740. https://www.mdpi.com/996976
Huang TY, Yu WHV, Chiang FY, Wu CW, Fu SC, Tai AS, et al. Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery. Front Endocrinol. 2021;12:788878. Doi: 10.3389/fendo.2021.788878. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635991/
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Giulia Ferreira Mattar Abdo, Giovanna Almeida Vital, Isadora Rover de Carvalho, Luisa Werneck Grillo, Bernardo Silva Costa Corrêa Alves

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.