Complications in thyroid surgery. Incidence and therapy

Developments in thyroid surgery during the last 20 years have reduced the n umber of complications significantly with rates from the literature of less than 1 % of laryngeal nerve paralysis and hypoparathyroidism. Specific pro blems are connected, however, with patients presenting with recurrent goitr es, requiring extended operations for Graves' disease and for malignant dis eases. Our own experience in almost 6,000 operations during the last 12 yea rs confirms the results from the literature with regard to more complicated thyroid surgery. Thus, laryngeal nerve paralysis in recurrent thyroid surg ery is between 2 and 8 %, depending on the extent of surgery, which is nece ssary. In surgical treatment of hyperthyroidism, permanent laryngeal nerve paralysis may be reduced to less than 1 %, while hypoparathyroidism is stil l a severe problem in patients with Graves' disease, and due to the necessi ty for an extensive operation is approximately 2 % in all cases. The same i s true for patients with thyroid malignancies who suffer from permanent lar yngeal nerve paralysis in 2-5 % and permanent hypoparathyroidism in 1-4 %, the range related to primary, secondary completion, or recurrent operation. The danger of postoperative bleeding still deserves special attention beca use it may be followed by life-threatening acute asphyxia. It is essential that surgeons also take care of all operative consequences at least by reco mmendating additional treatment.