Recurrent laryngeal nerve injury and hypoparathyroidism rates in reoperative thyroid surgery

Abstract

Objective: Reoperative thyroid surgery is rare and has a high complication rate. This retrospective cohort study was performed to determine the recurrent laryngeal nerve injury and hypoparathyroidism rates after reoperative thyroid surgery in two university hospitals in Benghazi, Libya. Material and Methods:All consecutive patients who underwent reoperative thyroid surgery between January 2002 and July 2014 were included retrospectively. The cohort was divided according to whether the reoperation was in the previously operated lobe or both lobes (ipsilateral group), or only in the previously non-operated lobe (contralateral group). Results:Of the 73 patients, 66 were female and seven were male. The median age was 37 (19-80) years. Nine (12.3%), five (6.8%), and one (1.4%) patient developed postoperative transient hypocalcemia, transient recurrent laryngeal nerve palsy, and permanent recurrent laryngeal nerve injury, respectively. None of the patients developed permanent hypocalcemia. The ipsilateral group had a higher rate of permanent recurrent laryngeal nerve injury after reoperation than the contralateral group (3.1% vs. 0%). It also had higher rates of transient recurrent laryngeal nerve injury (12.5% vs. 2.4%) and transient hypocalcemia (28.1% vs. 0%), but the two groups did not differ in terms of permanent hypocalcemia rates (both 0%). Conclusion:Reoperative thyroid surgery is technically challenging with a high incidence of complications. The ipsilateral group had more complications after reoperative thyroid surgery than the contralateral group. Hemi-or total thyroidectomy at the primary surgery is recommended to reduce the frequency of reoperative thyroid surgery.

Case report: coexistence of primary hyperparathyroidism with giant toxic nodular goiter

“…Reoperation for PHPT carries an increased risk for cure failure and incidence of complications, as postoperative scar formation and normal anatomical changes can increase the complexity and risks of parathyroid gland resection. This aggravates complications, such as recurrent laryngeal nerve injury and hypoparathyroidism [ 24 , 25 ]. Therefore, ultrasound-guided MWA was selected.…”

Incidental thyroid cancer in patients undergoing surgery for benign multinodular goitre: A retrospective clinical study

“…Especially when compared with primary TT; the rate of complications up to 5-10 times for permanent recurrent nerve paralysis and persistent hypoparathyroidism is quite striking [32][33][34]. On the other hand, no significant difference was reported between the patients who underwent TT for the first operation due to benign MNG and those who underwent subtotal thyroidectomy [35][36].…”

Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

“…So imaging cannot be relied upon to consider completion thyroidectomy. Intraoperative monitoring of RLN using nerve monitor during procedure might minimize the nerve damage, more so in case when previously operated site has to be explored [14].…”