Complications in the surgery of benign thyroid disease

Background: Thyroid surgery has developed from a life-threatening intervention in the last century to an efficient, wide-spread, and safe procedure for half a million goitre patients per year in Europe. The mortality of thyroid surgery has been reduced to a very low percentage due to progress in the control of bleeding and experience in the management of tracheal problems. It is the purpose of this report to review the actual problems in surgery of the benign thyroid. Methods: Data were collected from a large series (n = 5961 patients operated in our department between 1986 and 1998) and the literature. Results: The major specific complications in surgery of benign thyroid disease are palsy of the recurrent laryngeal nerve (RLN) at a rate of about 0.5-2.5% in primary surgery, about 3% in recurrent goitre, and 1.5-5% in retrosternal and recurrent retrosternal goitre. Whereas temporary hypocalcaemia is observed in about 30% of patients during the first postoperative days, temporary hypoparathyroidism necessitating substitution of calcium and active vitamin D is observed in about 6% of patients, its frequency increasing in more extended procedures and recurrences. Permanent hypoparathyroidism occurs in 0.5-4.0% of patients and may be reduced to below 1% by meticulous surgical technique and deliberate autotransplantation of all parathyroid glands with potentially compromised blood supply. Damage to the superior laryngeal nerve is an important, annoying, avoidable, but insufficiently recognized feature of thyroid surgery that needs further work-up. Conclusions: The risk of complications depends on the extent of surgery, the nature of the underlying disease, and the experience of the surgeon. Particular surgical problems are raised by recurrent thyroid disease, large glands, thyroid autonomy, retrosternal or even mediastinal localisation, and previous damage to the RLN or parathyroids. In such instances the patient should be referred to a specialised centre since the surgeon's experience can help to bring the rate of surgical complications down to those of ordinary procedures.