Thyroid & Adrenal
Complications Hemithyroidectomy include all of the following EXCEPT
|B||Injury to external branch of superior laryngeal nerve|
|C||Recurrent laryngeal nerve injury|
Management of Complications After Thyroidectomy
a. Hemorrhage is a rare but serious complication of thyroidectomy that usually occurs within 6 hours of surgery.
b. Management can require control of the airway by endotracheal intubation and, rarely, can require urgent opening of incision and evacuation of hematoma before return to the operating room for wound irrigation and ligation of the bleeding point.
B. Transient hypocalcemia
a. Transient hypocalcemia commonly occurs 24 to 48 hours after thyroidectomy but infrequently requires treatment.
b. Patients who are markedly symptomatic or who have serum calcium below 7 mg/dL are given one to two ampules (10 to 20 mL) of 10% calcium gluconate intravenously over 1 to 2 minutes, followed by temporary oral calcium carbonate (500 mg orally three times a day).
c. Permanent hypoparathyroidism is uncommon after total thyroidectomy.
d. Normal parathyroid tissue removed or devascularized at the time of total thyroidectomy must be minced into 1 × 3-mm fragments and autotransplanted into individual muscle pockets in the sternocleidomastoid muscle to maximize the chances that the patient will not develop postoperative hypoparathyroidism
C. Recurrent laryngeal nerve injury
a. Recurrent laryngeal nerve injury is a devastating complication of thyroidectomy that should occur rarely (<1%).
b. Unilateral RLN injury causes hoarseness, and bilateral injury compromises the airway, necessitating tracheostomy.
c. Repeat neck exploration, thyroidectomy for extensive goiter or Graves disease, and thyroidectomy for fixed, locally invasive cancers are procedures particularly prone to RLN injury.
d. Intentional (as with locally invasive cancer) or inadvertent transection of the RLN can be repaired primarily or with a nerve graft, although the efficacy of these repairs is not known.
e. Temporary RLN palsies can occur during thyroidectomy, and these usually resolve over a period of 4 to 6 weeks.
f. The external branch of the superior laryngeal nerve may be injured if it is not identified during ligation of the superior thyroid pole vascular bundle. This injury results in weakness of the patient's voice at high pitch.
g. The best prevention of these injuries is a thorough understanding of the anatomy of these nerves.