Is thyroidectomy in patients with Hashimoto thyroiditis more risky?

Abstract

Background Hashimoto’s thyroiditis (HT) is an organ –specific autoimmune disease characterized by production of antibodies such as anti-thyroperoxidase (TPO), which leads to destruction of the thyroid gland and a decrease in normal thyroid function. Thyroidectomy is performed when the patient presents with symptoms or when potential neoplastic degeneration occurs; however, surgery can be difficult due to the dense inflammatory process around the thyroid gland. We hypothesized that patients with HT may have a higher rate of complications following thyroid surgery. Methods We identified 1791 consecutive patients who underwent thyroidectomy from May 1994 to December 2009. Patients with HT were compared to without HT with regard to outcomes with ANOVA and Chi-squared (SPSS, Inc.). Results Patients with HT were significantly younger and more likely to be female. There was no significant difference between the two groups in the rate of malignancy. However, patients undergoing thyroidectomy with HT had a significantly higher postoperative complication rate. Specifically, the rates of overall complications, transient complications, and permanent complications were all increased in HT patients. Conclusion Patients with HT had a higher rate of complications after thyroidectomy when compared to patients without HT. Therefore, careful consideration must be taken prior to pursuing operative treatment in patients with HT including providing adequate informed consent regarding the increased risks of surgery.

Thyroid surgery performed on an overnight basis: a 17 years of experience

“…Three hemorrhages were observed in 174 (1.7%) cases, while in the entire group of patients, hemorrhage occurred in 41 (1.2%) patients subjected to all types of thyroidectomy (p = 0.599). These results are not in agreement with a study that analyzed 1,791 patients with significantly higher rates of postoperative complications, both transient and permanent, for this type of surgery (17,18).…”

Predicting difficulty of thyroidectomy preoperatively

“…Recurrent laryngeal nerve injury and hypoparathyroidism have the potential to be life-long, costly issues for a patient. 6,7 Traditionally thyroidectomy is performed as an inpatient surgery. This is out of concerns over possible complications including hematoma, hypocalcemia, laryngeal nerve damage and airway compromise.…”

“…These include thyroidectomy for Graves' disease, Hashimoto's thyroiditis, large goitre, or widely invasive thyroid carcinomas. 6,[9][10][11][12] For example, transient complications range from 12 -38% for patients with Hashimoto's thyroiditis and 11-28% for Graves' disease. 6,11,13 Permanent complications are also reported to be higher in these subsets.…”

Identifying Predictors of a Difficult Thyroidectomy

“…The main complications associated with thyroidectomy include injury to the recurrent laryngeal nerve, damage to the parathyroid glands, and postoperative hematoma. Recurrent laryngeal nerve injury and hypoparathyroidism have the potential to be life-long, costly issues for a patient (4)(5)(6). The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4)(5)(6).…”

“…Recurrent laryngeal nerve injury and hypoparathyroidism have the potential to be life-long, costly issues for a patient (4)(5)(6). The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4)(5)(6). Although certain disease states such as hyperthyroidism, goiter, and thyroiditis are associated with more difficult thyroidectomies, the degree of difficulty often varies widely, and it is difficult to quantify or predict the level of difficulty of these cases preoperatively (3,(5)(6)(7)(8)(9)(10)(11).…”