Thyroidectomy: Technique, Tips, and Troubleshooting

2018 ◽  
Author(s):  
Lindsay EY Kuo ◽  
Matthew A. Nehs
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Remote Access ◽  
Postoperative Hypocalcemia ◽  
Minimally Invasive Thyroidectomy ◽  
Perioperative Morbidity ◽  
Postoperative Hematoma ◽  
Thyroid Lobectomy

Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used. This review contains 9 figures, 1 table, and 29 references.  Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy

Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 225-227
Author(s):  
Zeki Acun ◽  
Fikret Cinar ◽  
Alper Cihan ◽  
Suat Can Ulukent ◽  
Lokman Uzun ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Thyroid Lobectomy ◽  
Laryngeal Nerve Injury

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

scholarly journals Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period

2021 ◽  
Vol 41 (6) ◽  
pp. 369-375
Author(s):  
Dauda Bawa ◽  
Amal Alghamdi ◽  
Hanan Albishi ◽  
Nasser Al-Tufail ◽  
Shashi Prabha Sharma ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Recurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
High Rate ◽  
Surgical Removal ◽  
Complications Of Thyroidectomy

BACKGROUND: Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent. OBJECTIVE: Summarize the frequency of surgical complications of thyroidectomy. DESIGN: Retrospective. SETTING: Secondary health facility in southwestern Saudi Arabia. PATIENTS AND METHODS: We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019. MAIN OUTCOME MEASURE: Complications following thyroidectomy. SAMPLE SIZE: 339 patients, 280 (82.6%) females and 59 (17.4%) males. RESULTS: We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma. CONCLUSION: The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications. LIMITATIONS: Retrospective design and no long-term follow up to monitor late complications. CONFLICT OF INTEREST: None.

scholarly journals Thyroidectomy for Graves’ Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study

2021 ◽  
pp. 000348942110212
Author(s):  
Sadaf Mohtashami ◽  
Keith Richardson ◽  
Veronique-Isabelle Forest ◽  
Alex Mlynarek ◽  
Richard J. Payne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Recurrent Laryngeal Nerve ◽  
Propensity Score Matching ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Graves Disease ◽  
Postoperative Hematoma ◽  
Laryngeal Nerve Injury

Objective: Examine the association of Graves’ disease with the development of postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016 to December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves’ disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’ disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves’ disease for thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other patients. The matched cohort showed that Graves’ disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery. There was no difference in recurrent laryngeal nerve injury among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to suffer from postoperative hematoma and hypocalcemia compared to patients undergoing surgery for other indications.

scholarly journals Clinical Complications Post Thyroidectomy

2020 ◽  
Vol 3 (1) ◽  
pp. 159-162
Author(s):  
Syed Abdul Hakeem
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
General Surgeon ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Metabolic Disturbances ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Injury

Background: One of the most commonly conducted operations by a general surgeon are thyroid surgeries. Many complications of thyroid operation are linked to metabolic disturbances or a recurrent laryngeal nerve injury. Superior laryngeal nerve injury, inflammation, weakness  of airways and bleeding are other risks. Subjects and Methods: This randomized retrospective sample consists of 50 successive patients who undergo various thyroidectomy procedures and who meet the inclusion criteria after having been introduced to OPD. Results: Post-operative complications following thyroidectomy was seen in 30% of the patients with Hypocalcemia being one of the most prevalent complications postoperatively observed in 18% of the patients followed by wound infection seen in 6% of the cases studied. The frequency of hematoma at the surgical site was 2%. Recurrent Laryngeal Nerve paralysis seen in 2% of the cases and Seroma formation was reported in one individual constituting 2% of the cases. Conclusion: Effective patient surgical control is important and assists in the early detection and treatment of such complications.Careful post-operative patient monitoring ensures quick intervention and helps the patient to achieve better results.

scholarly journals Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery

2015 ◽  
Vol 6 (4) ◽  
pp. 149-154
Author(s):  
Chetan Bansal ◽  
Aparna Bhardwaj ◽  
Sonam Rathi ◽  
Alok Agrahari ◽  
Virendra P Singh
Keyword(s):  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Tertiary Care ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

ABSTRACT Background To study the frequency of postoperative complications after thyroid surgery indicated for various benign and malignant lesions and to corroborate the results in relation to the extent of surgery and a clinical overview of evolution of thyroid surgery. Materials and methods An analytical study was carried out at a tertiary care center over a period of 3 years from January 2011 to December 2013. Data were collected from 80 patients who underwent thyroidectomies for various thyroid diseases at this center. Results Hemithyroidectomy, isthmusectomy, subtotal, neartotal, and total thyroidectomies were performed in 36 (45%), 6 (7.5%), 8 (10%), 10 (12.5%), and 20 (25%) cases respectively. The overall postoperative complication rate was 20%. Postoperative hypocalcemia and recurrent laryngeal nerve injury were the most common complications. Permanent hypocalcemia and permanent recurrent laryngeal nerve injury were observed in 3.75 and 2.5% of all operated cases respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in our series. Conclusion The overall complication rate can be minimized by operating in a bloodless field, doing a meticulous dissection, and correctly identifying and preserving recurrent and superior laryngeal nerves along with parathyroid glands, if feasible. How to cite this article Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, Singh VP, Rathi S. Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. Int J Head Neck Surg 2015;6(4):149-154.

Preservation of the Laryngeal Nerves during Total Thyroid Lobectomy

1977 ◽  
Vol 86 (6) ◽  
pp. 777-788 ◽  
Author(s):  
John M. Loré ◽  
Duck J. Kim ◽  
Samir Elias
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
External Branch ◽  
Thyroid Lobectomy ◽  
Maximum Protection

A technique of exposure and preservation of the recurrent laryngeal nerve at the very onset of thyroidectomy and preservation of the external branch of the superior laryngeal nerve at the close of the procedure is described, which is believed to afford maximum protection to these nerves during total thyroid lobectomy and isthmusectomy as well as total thyroidectomy. At the same time, preservation of the parathyroid glands is achieved. In 120 exposures and preservations of the recurrent laryngeal nerve there have been no instances of a single permanent paralysis of this nerve. In 111 total thyroid lobectomies in which the external branch of the superior laryngeal nerve was placed in jeopardy, only one patient had a slight bowing of the vocal cord with excellent voice function during a limited follow-up period.

Correlation between Stroboscopy and Electromyography in Laryngeal Paralysis

1993 ◽  
Vol 102 (11) ◽  
pp. 852-857 ◽  
Author(s):  
John Kokesh ◽  
Lawrence R. Robinson ◽  
Paul W. Flint ◽  
Charles W. Cummings
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Therapeutic Intervention ◽  
Vocal Fold ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Previous Surgery ◽  
Laryngeal Paralysis ◽  
The Status ◽  
Laryngeal Nerve Injury ◽  
Vocal Fold Motion

Twenty patients with vocal fold motion impairment were reviewed to correlate the findings of electromyography (EMG) and stroboscopy. The causes of motion impairment were idiopathic, previous surgery with recurrent laryngeal nerve injury, neck and skull base trauma, and neoplasm. The EMG studies were analyzed to assess the status of innervation of the immobile vocal fold. The presence or absence of the mucosal wave prior to therapeutic intervention was determined with stroboscopic examination. Eight of 10 patients with EMG evidence of reinnervation or partial denervation were found to have mucosal waves, and 3 of 10 patients with EMG evidence of denervation were found to have mucosal waves. Six patients developed mucosal waves after surgical medialization, despite evidence of denervation by EMG criteria. These findings support the premise that tension and subglottic pressure, rather than status of innervation, determine the presence of the mucosal wave.

scholarly journals Recurrent laryngeal nerve injury in thyroid surgery: a review

2012 ◽  
Vol 83 (1-2) ◽  
pp. 15-21 ◽  
Author(s):  
Nathan James Hayward ◽  
Simon Grodski ◽  
Meei Yeung ◽  
William R. Johnson ◽  
Jonathan Serpell
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury
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