[Incidence of complications of thyroid surgery].
BACKGROUND
Thyroid surgery presents a low incidence of complications. Death is certainly a rare, or even exceptional event. Hypoparathyroidism, above all if definitive, is the main complication of total thyroidectomy with percentages that very between 0 and 10% in the literature (average 2%).


METHODS
The incidence of recurrent lesions varies between an improbable 0% to 8%, whereas lesions to the superior laryngeal nerve are relatively frequent, but often undervalued. Dysphagia, although always transient, presents a high risk of pneumonia ab ingestis and severe dehydration. Hemorrhage has an incidence of 0.1-3.8% and infection is reported in approximately 1% of cases. The permanent and recurrence nature of thyroid pathology in literature is between 5 and 11%, resulting from inadequate or sometimes useless surgery. Hypothyroidism is the logical consequence of total thyroidectomy. In the light of these data we have re-examined 300 operations involving thyroid pathology performed by the same team using the same method over the past 4 years (82% females, 18% males). 33% of the cases presented benign euthyroid nodular pathology, 27% hyperfunctioning benign nodular pathology, 2.6% Flajani-Basedow-Graves disease, 9% were adenomas, 7% were differentiated carcinomas, 2% anaplastic carcinomas and 0.7% medullary carcinomas. 99 extracapsular total loboisthmectomies, 135 total extracapsular thyroidectomies and 66 subtotal thyroidectomies were performed.


RESULTS
The following complications were observed: 31/300 symptomatic hypocalcemias of which 25 were transient and 6 (2%) were definitive but easily controlled with treatment; 9 recurrent monoplegias out of 501 isolated recurrent forms of which 4 (0.8%) was permanent; 5/300 (1.7%) postoperative dysphagias associated with recurrent monoplegia in 4 cases. Damage to the external branch of the superior laryngeal nerve was suspected in 11/300 cases (3.7%). Postoperative hemorrhage occurred with an incidence of 1.3%, whereas the incidence of wound infection and serous collection was 1.7%. Moreover, persistent hyperthyroidism after subtotal bilateral thyroidectomy was observed secondary to toxic plurinodular struma. A case of paralysis of the right ulnar nerve, when the arm was adducted, was observed on the operating table, but regressed after about 4 months. Mortality was zero.


CONCLUSIONS
Thyroid surgery is still hampered by a relatively low percentage of complications, which are probably still the result of various technical limitations, and it appears difficult to reduce these, let alone eliminate them completely.
Rosato
L
L
UOA di Chirurgia Generale, Regione Piemonte, ASL 9, Ivrea Ospedali Riuniti del Canavese, Sede di Ivrea.
Mondini
G
G
Ginardi
A
A
Clerico
G
G
Pozzo
M
M
Raviola
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013959:Thyroid Diseases / Q000601:surgery*