COMPLICATIONS OF THYROID-SURGERY

Background: The morbidity of thyroid surgery is low. Despite this, som e authors advocate a subtotal thyroidectomy instead of a total thyroid ectomy, to avoid the higher morbidity associated with a total thyroide ctomy. Methods: We retrospectively evaluated the complications of thyr oid surgery in Leiden between January 1, 1982 and October 1, 1990. Thr ee hundred forty-one patients-261 women and 80 men-had 356 operations; 15 patients were operated on twice; there were 152 total hemithyroide ctomies, 3 subtotal hemithyroidectomies, 33 total thyroidectomies, 122 bilateral subtotal hemithyroidectomies, 12 combinations of total and subtotal hemithyroidectomies, and 34 other operations. Results: Calcul ated for the nerves at risk (n = 489), the percentage of permanent rec urrent nerve lesions was 3.1 (in the 5 most recent years it was 1.2%). There was no significant difference between total or subtotal (hemi)t hyroidectomies. Initial symptomatic hypocalcemia necessitating supplem entation was encountered 42 times (12.5%). The occurrence of permanent symptomatic hypocalcemia (6%) was not significantly different between total and subtotal (hemi)thyroidectomies (p = 0.06). The duration of surgery was 137.8 min for bilateral subtotal thyroidectomies and 182.9 min for bilateral total thyroidectomies (p < 0.0001). There was no di fference in blood loss between total and subtotal (hemi)thyroidectomie s. Conclusions: Because total thyroidectomy carries a risk of complica tions similar to that for subtotal thyroidectomy, it is not logical to avoid total resections. If the number of total resections were increa sed, it is anticipated that fewer reoperations, which involve a relati vely high morbidity rate, would have to be performed.