THYROID REOPERATIONS - INDICATIONS AND RISKS

Thyroid reoperations can be technically difficult and associated with an increased risk of complications. To determine the indications for r eoperations and the risk of postoperative complications with these pro cedures, records of 362 patients undergoing thyroidectomy by a single surgeon (R.A.P.) were reviewed. Thirty-two patients had a reoperation. The group consists of 21 women and 11 men with an average age of 55 y ears (range, 31-79). Twenty-four patients had 1 prior operation, and 8 patients had 2 or more. We performed 4 of the initial operations, and 28 were done by surgeons at other centers. Fourteen reoperations were done for symptomatic multinodular goiter (MNG), and 5 because of a ch ange in the histologic diagnosis from benign to cancerous. The remaind er were for further treatment of malignancy. The most common operation was completion thyroidectomy (31). In 3 patients, either unilateral o r bilateral modified radical neck exploration was performed. One patie nt required median sternotomy. One subtotal thyroidectomy was also per formed. Recurrent laryngeal nerve injury occurred in 2 patients. It re solved in 1 patient but was permanent in another, who had 3 operations for MNG. One of the 2 patients with preoperative unilateral vocal cor d paralysis had return of function after removal of a substernal goite r. The other had a permanent nerve injury from the original surgery. T hree patients had postoperative hypocalcemia (calcium <8.0 mg/dL). Thi s resolved in all patients within 1 to 6 months. One patient who had a third operation for MNG had postoperative hemorrhage necessitating tr acheostomy for airway control. Another patient developed a seroma that resolved within 2 months. We conclude that reoperations are indicated for both benign and malignant thyroid disease. Because they carry a h igher risk of complications, every effort should be made to avoid them by performing definitive initial treatment.