Factors Associated with Thyroid Surgery Complications at Maharat Nakhon Ratchasima Hospital
DOI:
https://doi.org/10.64387/tjs.2025.272747Keywords:
Thyroidectomy, Postoperative complications, PredictorsAbstract
Background: Thyroidectomy is one of the most frequently performed operations for thyroid disease. Thyroidectomy was associated with increased morbidity and even mortality. Potential major complications of thyroid surgery include bleeding (0.3-1%), injury to the RLN (4- 6.6%) if the nerve is not identified), hypoparathyroidism (2-53%), hypothyroidism (5-41.9%), thyrotoxic storm (< 0.5%), injury to superior laryngeal nerve (0-25%), and infection (1-2%). This study assessed the current understanding of factors predicting such complications following thyroidectomy.
Objectives: To investigate factors associated with complications in thyroid surgery.
Materials and Methods: We performed a retrospective analysis of all patients aged > 15 years who underwent thyroid surgery for any thyroid disease at our institution between October 2022 and September 2023. Data was analyzed regarding demographics, clinical features, operative details, postoperative complications, and histopathology results of tissue specimens.
Results: A total of 278 patients were identified, comprising 187 females (67.26%) and 91 males (32.74%). 106 surgical complications were observed in 77 patients (27.7%). The most common complication in the study was hypocalcemia, occurring in 54 cases (19.4%). This was followed by hoarseness in 42 cases (15.1%). The final model revealed that subtotal/total thyroidectomy had a strong and significant association with complications (adjusted RR: 4.15; 95% CI: 2.63-6.55; p < 0.001). Similarly, a disease duration exceeding 10 years (adjusted RR: 1.46; 95% CI: 1.09–1.97; p = 0.012) and thyroid nodule weight exceeding 200 gm. was also statistically significant adjusted RR: 2.11; 95% CI: 1.05-4.24; p = 0.035).
Conclusion: The postoperative complications of thyroid surgery were associated with the subtotal/total thyroidectomy, a disease duration exceeding 10 years, and thyroid nodule weight exceeding 200 gm. Therefore, special caution must be exercised in patients with these characteristics.
References
Ernandes-Neto M, Tagliarini JV, López BE, et al. Factors influencing thyroidectomy complications. Braz J Otorhinolaryngol. 2012;78(3):63-9. doi: 10.1590/S1808-86942012000300012.
Karamanakos SN, Markou KB, Panagopoulos K, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens). 2010;9(4):318-25. doi: 10.14310/horm.2002.1283.
Wondwosen M, Bekele M, Abebe K, et al. Factors associated with thyroidectomy complications in resource-limited settings: An observational study. Int J Surg Open. 2022;42:100468. doi: 10.1016/j.ijso.2022.100468.
Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci. 2010;25(4):541-5. doi: 10.3346/jkms.2010.25.4.541.
Samranwanich B. complications after surgery for well-differentiated thyroid carcinoma in Otolaryngology Department, Maharat Nakhon Ratchasima Hospital (in Thai). Thai Cancer J. 2019;39(3):93-102.
Khundam W. The study of complication of thyroid surgery among patients at Sichon Hospital, Nakhon Si Thammarat. Reg 11 Med J. 2018;32(4):1315-26.
Gurrado A, Bellantone R, Cavallaro G, et al. Can total thyroidectomy be safely performed by residents?: A Comparative Retrospective Multicenter Study. Medicine (Baltimore). 2016;95(14):e3241. doi: 10.1097/MD.0000000000003241.
Culp JM, Patel G. Recurrent laryngeal nerve injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023.
Jeannon JP, Orabi AA, Bruch GA, et al. Diagnosis of Recurrent Laryngeal Nerve Palsy after Thyroidectomy: A Systematic Review. Int J Clin Pract. 2009;63(4):624-9. doi: 10.1111/j.1742-1241.2008.01875.x.
Faul F, Erdfelder E, Lang AG, et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. doi: 10.3758/bf03193146.
Hermann M, Keminger K, Kober F, et al. Risk factors in recurrent nerve paralysis: a statistical analysis of 7566 cases of struma surgery (in German). Chirurg. 1991;62(3):182-7; discussion 188.
Zambudio AR, Rodríguez J, Riquelme J, et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004;240(1):18-25. doi: 10.1097/01.sla.0000129357.58265.3c.
Thomusch O, Machens A, Sekulla C, et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-5. doi: 10.1067/msy.2003.61.
Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28(3):271-6. doi: 10.1007/s00268-003-6903-1.
Zakaria HM, Al Awad NA, Al Kreedes AS, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J. 2011;26(1):34-8. doi: 10.5001/omj.2011.09.
Mintziras I, Ringelband R, Jähne J, et al. Heavier weight of resected thyroid specimen is associated with higher postoperative morbidity in benign goiter. J Clin Endocrinol Metab. 2022;107(7):e2762-e2769. doi: 10.1210/clinem/dgac214.
Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg. 2000;24(8):971-5. doi: 10.1007/s002680010160.
de Gier HH, Balm AJ, Bruning PF, et al. Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck. 1996;18(4):347-51. doi: 10.1002/(SICI)1097-0347(199607/08)18:4<347::AID-HED6>3.0.CO;2-Y.
Crumley RL, Smith JD. Postoperative chylous fistula prevention and management. Laryngoscope. 1976;86(6):804-13. doi: 10.1288/00005537-197606000-00008.
Gregor RT. Management of chyle fistulization in association with neck dissection. Otolaryngol Head Neck Surg. 2000;122(3):434-9. doi: 10.1016/S0194-5998(00)70061-1.
Rodgers GK, Johnson JT, Petruzzelli GJ, et al. Lipid and volume analysis of neck drainage in patients undergoing neck dissection. Am J Otolaryngol. 1992;13(5):306-9. doi: 10.1016/0196-0709(92)90053-v.
Merante Boschin I, Meduri F, Toniato A, Cervical lymphorrea after nodal dissection: role of fasting based on clinical evidence (in Italian). Minerva Chir. 2006;61(1):57-62.
Ulíbarri JI, Sanz Y, Fuentes C, et al. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet. 1990;336(8709):258. doi: 10.1016/0140-6736(90)91793-a.
Valentine CN, Barresi R, Prinz RA. Somatostatin analog treatment of a cervical thoracic duct fistula. Head Neck. 2002;24(8):810-3. doi: 10.1002/hed.10103.
Casler JD, Brietzke SE. Repair of a high-output chylous fistula with a free fat graft. Laryngoscope. 1998;108(6):938-40. doi: 10.1097/00005537-199806000-00027.
Selle JG, Snyder WH 3rd, Schreiber JT. Chylothorax: indications for surgery. Ann Surg. 1973;177(2):245-9. doi: 10.1097/00000658-197302000-00022.
![[TJS 46-3 02] Table 3 Multivariable regression model of factors associated with postoperative complications](https://he02.tci-thaijo.org/public/journals/683/submission_272747_57036_coverImage_en_US.jpg)
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Royal College of Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
