Complications in thyroid surgery. Incidence and therapy

Developments in thyroid surgery during the last 20 years have reduced the number of complications significantly with rates from the literature of less than 1 % of laryngeal nerve paralysis and hypoparathyroidism. Specific problems are connected, however, with patients presenting with recurrent goitres, requiring extended operations for Graves' disease and for malignant diseases. Our own experience in almost 6,000 operations during the last 12 years confirms the results from the literature with regard to more complicated thyroid surgery. Thus, laryngeal nerve paralysis in recurrent thyroid surgery is between 2 and 8 %, depending on the extent of surgery, which is necessary. In surgical treatment of hyperthyroidism, permanent laryngeal nerve paralysis may be reduced to less than 1 %, while hypoparathyroidism is still a severe problem in patients with Graves' disease, and due to the necessity for an extensive operation is approximately 2 % in all cases. The same is true for patients with thyroid malignancies who suffer from permanent laryngeal 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 because it may be followed by life-threatening acute asphyxia. It is essential that surgeons also take care of all operative consequences at least by recommending additional treatment.