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2017 Month : January Volume : 6 Issue : 5 Page : 413-418

A STUDY OF POST-OPERATIVE COMPLICATIONS OF THYROID SURGERY.

P. Anbalagan1, S. Manikannan2, A. Mohammed Imran Khan3

Corresponding Author:
Dr. P. Anbalagan,
Assistant Professor,
Department of General Surgery,
Government Vellore Medical College and
Hospital, Vellore.
E-mail: anbalagan_88chemco@yahoo.com

ABSTRACT

BACKGROUND

The aims of the study are– 1. To compare complication rates of bilateral Sub-Total Thyroidectomy (SBT), Near Total Thyroidectomy (NTT), Hemithyroidectomy (total lobectomy and isthmusectomy) and Total Thyroidectomy (TT) in cohort of patients undergoing surgery for various thyroid disorders. 2. To compare complication rates after thyroidectomy for benign diseases and malignant diseases. To identify ways to avoid the post-operative complications.

MATERIALS AND METHODS

One hundred and seventeen patients who underwent thyroid surgery for various thyroid disorders at the Government Vellore Medical College Hospital, Vellore, Tamilnadu, India between January 2014 and January 2016 were studied. Operations were performed by various Professors, Assistant Professors and also by Surgical Post Graduates supervised by senior surgeons using various surgical techniques. Indications for surgery in this study group include forty-five patients with non-toxic Multinodular Goitre (MNG), twenty-two patients with toxic multinodular goitre, thirty-four patients with nontoxic solitary nodular goitre, thirteen patients with carcinoma, two patients with recurrent goitre and one patient with colloid goitre. Of these one hundred and seven patients were female and ten patients were male. These patients were broadly divided into two categories based on the diagnosis and treatment modality. For all selected patients, a thorough history was elicited followed by a complete physical examination. The basic biochemical and haematological investigations were done for all patients. It was decided to request special investigations like thyroid hormone profile and serum calcium estimation only in selected cases, where a disturbance in the functional status was suspected. Vocal cords were examined pre-operatively by indirect laryngoscope in all the patients, whereas post-operative vocal cord examination was performed only when hoarseness occurred. Patients were classified as having hypocalcaemia (Hyperparathyroidism) if both clinical and biochemical (A fall in corrected serum calcium concentration below 8 mg/dL and/or the need for calcium supplementation), supportive evidence were present. FNAC was done for all patients. Based on the final diagnosis, the treatment was given as advised by the experts.

RESULTS

The following conclusions are drawn from this study. 1. This study shows that the total thyroidectomy or hemithyroidectomy can be done with very low complication rate in cases of benign thyroid disease affecting the whole gland. 2. Hypoparathyroidism, however, is a relatively common and significant complication than the recurrent laryngeal nerve injury after surgery for thyroid disorders. 3. Thyroid carcinoma, recurrent goitre, toxic goitre and total thyroidectomy are risk factors for post-operative complication. 4. Complication rates are similar for bilateral subtotal thyroidectomy and total thyroidectomy, and there is a risk of recurrence with bilateral subtotal thyroidectomy. Because total thyroidectomy carries a risk of complication similar to that for bilateral subtotal thyroidectomy, it is not logical to avoid total resections. Therefore, near total or total thyroidectomy may be the operation of choice for multinodular goitre. 5. Complications and sequelae of thyroid surgery can yet be reduced by careful evaluation of the surgical and medical therapeutic options have more precise surgical indications, a thorough knowledge of the surgical anatomy, a rigorous surgical technique, a systematic dissection of recurrent laryngeal nerve and parathyroid gland in case of bilateral operation and meticulousness during the procedure.

CONCLUSION

1. This study shows that the total thyroidectomy or hemithyroidectomy can be done with very low complication rate in cases of benign thyroid disease affecting the whole gland. 2. Hypoparathyroidism, however, is a relatively common and significant complication than the recurrent laryngeal nerve injury after surgery for thyroid disorders. 3. Thyroid carcinoma, recurrent goitre, toxic goitre and total thyroidectomy are risk factors for post-operative complication.

KEYWORDS

Sub-Total Thyroidectomy, Hemi-Thyroidectomy, Near Total Thyroidectomy, Multinodular Goitre.

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