Int J Thyroidol.  2024 Nov;17(2):251-258. 10.11106/ijt.2024.17.2.251.

How to Minimize the Complications of Thyroid Surgery

• Lee KD
• Kim YJ

• KMID: 2561604
• DOI: http://doi.org/10.11106/ijt.2024.17.2.251

Abstract

The main goal of thyroid cancer treatment is to completely remove the lesion and minimize recurrence. However, given the very favorable prognosis and the quality of life following the extended lifespan after surgery, completing the surgery without complications is just as important as the complete removal of the cancer. Preventing surgical complications is very important, and the experience of the thyroid surgeon is the most critical factor. Therefore, overcoming the occurrence of complications is a necessary step that a novice must take to become a competent thyroid surgeon. With this background in mind, the author believes that ‘thyroid surgery is a battle with the laryngeal nerves, parathyroid, and blood vessels.’ This review aims to describe methods to minimize postoperative bleeding and hypoparathyroidism based on the author’s experience.

Keyword

Thyroidectomy; Postoperative hemorrhage; Hypoparathyroidism

Figure

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  Fig. 1 Superficial hemtoma from a branch of the anterior jugular vein. Even if the hematoma enlarges significantly, the swelling typically occurs towards the skin rather than the airway. Additionally, as the hemoglobin from the hematoma diffuses towards the skin surface, it causes severe ecchymosis. Despite the neck swelling, there were no symptoms of respiratory distress.

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  Fig. 2 Laryngoscopic findings in a deep hematoma patient 7 days post-hemorrhage. The findings reveal persistent purple discoloration and edema of the posterior pharyngeal wall, arytenoids, false cords, epiglottis, and vocal cords.

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  Fig. 3 Superficial Hematoma above the strap muscle. The hematoma is situated between the skin flap and the strap muscle. This condition can lead to skin ecchymosis but rarely causes dyspnea, as there is minimal compression of the laryngopharynx or trachea.

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  Fig. 4 Near infrared autofluorescence from parathyroid. The strong intensity of parathyroid autofluorescence enable the surgeon discriminate the parathyroid gland from the thyroid fat, muscle, and trachea.

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  Fig. 5 Parathyroid gland mapping with NIRAF imaging. (A) Left thyroid lobe is mobilized but inferior PG is not yet exposed. At this stage, the NIR light is illuminated on the area where the PG is expected to be located. (B) Early localization (mapping) of the PG still veiled by the fatty connective tissue is possible with the NIRAF imaging. (C) Inferior PG is definitely identified by dissecting the connective tissue based on the image. (D) After exposure, the autofluorescence intensity of the PG becomes slightly stronger.17) PG: parathryoid gland

Reference

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