Complications in thyroid surgery – retrospective analysis

Česká verze

Authors: A. Stolz ; P. Bavor; M. Kučerová; V. Král; F. Pazdírek
Authors place of work: Chirurgická klinika 2. LF UK a FN Motol a Homolka, Praha
Published in the journal: Rozhl. Chir., 2026, roč. 105, č. 4, s. 162-168.
Category: Původní práce
doi: https://doi.org/10.48095/ccrvch2026162

Summary

Introduction: Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications. But they can have a major impact on the quality of life of patients.

Methods: A retrospective analysis of our prospective database of patients after thyroid surgery at the Department of Surgery of the 2^nd Faculty of Medicine, Charles University, and Motol University Hospital in Prague operated on in the period 2021–2024 was performed. Patients who underwent total thyroidectomy or lobectomy were included in the study.

Results: Totally 1,559 patients with an average age of 52.1 years were included in the study. There were 1,280 female patients (82.1%). Malignant disease occurred in 375 patients (22.9%). Total thyroidectomy (TTE) was performed in 1,086 patients (69.9%), lobectomy (LE) in 473 patients (30.1%). Total nerves at risk were 2,645. We identified transient unilateral paresis of the recurrent laryngeal nerve (NLR) in a total of 39 patients (1.47%), of which 29 patients after TTE and 10 patients after LE. Permanent unilateral paresis was present in 20 patients (0.75%). Bilateral postoperative NLR paresis occurred in 4 patients (0.36%). Postoperative hypocalcemia occurred in 66 patients after TTE (6.1%). Postoperative hypocalcemia developed in 66% of patients within 24 hrs from surgery and in 96% within 48 hrs. Postoperative bleeding requiring surgical revision occurred in 45 patients (2.8%). The interval from the original operation to the reoperation was 10.4 ± 10.3 hrs, median 6.5 hours.

Conclusion: Surgical therapy of the thyroid gland is associated with a low rate of complications, which, however, can have a major impact on the quality of life of patients. Perfect knowledge of the anatomy of the thyroid gland together with precise surgical technique and consistent hemostasis are the basis of safe thyroid surgery.

Keywords:

hypocalcemia – postoperative complications – thyroidectomy

Zdroje

1. Weiss A, Lee KC, Brumund KT et al. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014; 156 (2): 399–404. doi: 10.1016/j.surg.2014.03.015.

2. de Carvalho AY, Gomes CC, Chulam TC et al. Risk factors and outcomes of postoperative neck hematomas: an analysis of 5,900 thyroidectomies performed at a cancer center. Int Arch Otorhinolaryngol 2021; 25 (3): 421–427. doi: 10.1055/s-0040-1714129.

3. Fan C, Zhou X, Su G et al. Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta--analysis. BMC Surg 2019; 19 (1): 98. doi: 10.1186/s12893-019-0559-8.

4. Wojtczak B, Sępek M, Sutkowski K et al. Changes in thyroid surgery over last 25 years. Sci Rep 2025; 15 (1): 14432. doi: 10.1038/s41598-025-99191-6.

5. Canu GL, Medas F, Cappellacci F et al. Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study). Front Surg 2023; 10 : 1278696. doi: 10.3389/fsurg.2023.1278696.

6. Materazzi G, Ambrosini CE, Fregoli L et al. Prevention and management of bleeding in thyroid surgery. Gland Surg 2017; 6 (5): 510–515. doi: 10.21037/gs.2017.06.14.

7. Vidura R. Rizikové faktory tranzitorní hypoparatyreózy a stanovení jejich statistické významnosti po operacích štítné žlázy. Otorinolaryngol Foniatr 2007; 56 (1): 18–23.

8. Lukáš J, Astl J, Paska J et al. Incidence komplikací u operací štítné žlázy. Retrospektivní analýza. Otorinolaryngol Foniatr 2017; 66 (2): 66–70.

9. Kostek M, Cetinoglu I, Sengul Z et al. Clinical significance and risk factors of incidental parathyroidectomy after total thyroidectomy. Endocrine 2025; 89 (1): 240–249. doi: 10.1007/s12020-025-04225-8.

10. van Dijk SP, Maas CCHM, Alshangi Aet al. Development and validation of a prognostic model for persistent hypoparathyroidism after total or completion thyroidectomy. Clin Otolaryngol 2026; 51 (1): 111–120. doi: 10.1111/coa.70039.

11. Hayward NJ, Grodski S, Yeung M et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg 2013; 83 (1–2): 15–21. doi: 10.1111/j.1445-2197.2012.06247.

12. Astl J, Plzák J, Laštůvka P et al. Morbidity and mortality associated with thyroid surgery –retrospective analysis 1991−2010. Rozhl Chir 2021; 100 (3): 118–125. doi: 10.33699/PIS.2021.100.3.118-125.

13. Alqahtani SM, Al-Sohabi HR, Rayzah MF et al Recurrent laryngeal nerve injury after thyroidectomy: a national study from Saudi Arabia. Saudi Med J 2023; 44 (1): 80–84. doi: 10.15537/smj.2023.44.1.20220710.

14. Obata K, Kurose M, Kakiuchi A et al. Factors of postoperative recurrent laryngeal nerve paralysis and recovery of vocal cord movement in thyroid surgery. Auris Nasus Larynx 2024; 51 (5): 892–897. doi: 10.1016/j.anl.2024.08.006.

15. Jatzko GR, Lisborg PH, Müller MG et al. Recurrent nerve palsy after thyroid operations-principal nerve identification and a literature review. Surgery 1994; 115 (2): 139–144.

16. Thomusch O, Machens A, Sekulla Cet al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000; 24 (11): 1335–1341. doi: 10.1007/s002680010221.

17. Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000; 135 (2): 204–207. doi: 10.1001/archsurg.135.2.204.

18. Sosa JA, Bowman HM, Tielsch JM et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998; 228 (3): 320–330. doi: 10.1097/00000658-199809000-00005.

19. Dralle H, Sekulla C, Haerting J et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004; 136 (6): 1310–1322. doi: 10.1016/j.surg.2004.07.018.

20. Dionigi G, Boni L, Rovera F et al. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg 2010; 395 (4): 327–331. doi: 10.1007/s00423-009-0581-x.

21. Li W, Li H, Zhang S et al. To explore the risk factors and preventive measures affecting the treatment of retrosternal goiter: an observational study. Medicine (Baltimore) 2020; 99 (44): e23003. doi: 10.1097/MD.0000000000023003.

22. Švorcová M, Libánský P, Fialová M et al. Retrosternal goiter. Rozhl Chir 2020; 99 (11): 492–496. doi: 10.33699/PIS.2020.99.1.492-496.

23. Al-Hakami HA. The value of intraoperative neuromonitoring and neurostimulation in thyroid surgery: a single-center retrospective analysis and prospective follow-up. Medicine (Baltimore) 2025; 104 (38): e44621. doi: 10.1097/MD.0000000000044621.

24. Calò PG, Pisano G, Medas F et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg 2014; 43 (1): 16. doi: 10.1186/1916-0216-43-16.

25. Astl J, Holý R, Rotnágl J et al. Neuromonitoring of recurrent laryngeal nerves in thyroid surgery comparative study of visualisation and electrophysiology methods. Rozhl Chir2021; 100 (3): 113–117. doi: 10.33699/PIS.2021.100.3.113-117.

26. Roberts SL, El-Shikh M, Alam P et al. Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy. Br J Oral Maxillofac Surg 2023; 61 (10): 679–685. doi: 10.1016/j.bjoms.2023.10.001.

27. Javed A, Alburaiki A, Sharma N et al. Utilisation of near infrared autofluorescence in parathyroid identification during thyroidectomy: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2025; 50 (4): 609–618. doi: 10.1111/coa.14313.

28. Rudin AV, McKenzie TJ, Thompson GB et al. Evaluation of parathyroid glands with indocyanine green fluorescence angiography after thyroidectomy. World J Surg 2019; 43 (6): 1538–1543. doi: 10.1007/s00268-019-04909-z.