Complications of thyroidectomy at a tertiary health institution in Nigeria

Abstract

Introduction: Thyroid surgeries are the most common endocrine surgeries performed all over the world. The procedure has been through tremendous evolution to enhance patient safety. In spite improved techniques, every thyroid surgeon has come across complications with this operation. This is a retrospective study of complications of thyroidectomies at a tertiary health institution in Abuja, Nigeria. The study highlights some of the complications encountered at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, following thyroid surgeries by General surgeons. Aim: This article aimed to determine the complication rates after thyroidectomies in our institution and proffer efficient methods of complication management, thus reducing postoperative morbidity and mortality. Material and Methods: A retrospective study of complications arising from consecutive thyroidectomies was carried out in the University of Abuja Teaching Hospital for over a 5-year period between January 1, 2012 and December 31, 2017. Clinical data on each case were extracted from patient folders using a structured questionnaire. Data was analyzed using SPSS, IBM version 21. Results: A total of 72 thyroidectomies were carried out during the period. There were seven males and 65 females with M:F ratio of 1:9. The median age of the patients was 38.5 years (range 18–75 years). Preoperative diagnoses included simple goiter (n\u2009=\u20096, 8.3%), nontoxic multinodular goiter (n\u2009=\u200951, 70.8%), toxic nodular goiter (n\u2009=\u20096, 8.3%), Grave’s disease (n\u2009=\u20092, 2.8%), toxic multinodular goiter (n\u2009=\u20095, 6.9%), simple multinodular goiter (n\u2009=\u20091, 1.4%), and others such as solitary thyroid cyst (n\u2009=\u20091, 1.4%) . The operations were total thyroidectomy (n\u2009=\u200915, 20.8%), subtotal thyroidectomy (n\u2009=\u200913, 18.1%), near-total thyroidectomy (n\u2009=\u200933, 45.8%), lobectomy (n\u2009=\u200910, 13.9%), and extended lobectomy (n\u2009=\u20091, 1.4%); 72.1% of the patients had no complications whereas 27.9% of the patients developed complications. The complications were temporary recurrent laryngeal nerve (RLN) palsy 9.7%, recurrent goiter 1.4%, hypothyroidism 1.4%, hypocalcemia 5.6%, hypertrophic scar formation 5.6%, and hematoma collection 4.2%. No patient developed wound infection, transient or permanent hypoparathyroidism, permanent RLN palsy, superior laryngeal nerve palsy, recessed scar, or mortality. All the patients were followed up for a period of 1 to 5 years. Conclusion: Thyroidectomy is safe in our institution. The complication rate of 27.9% is high, however, this is a summation of all complications recorded at the institution. Most of the complications were minor and resolved with conservative measures in 3 to 6 months. The dreaded complications of thyroidectomy such as permanent RLN injury, wound infection, and mortality is zero (0)% each. Careful patient selection and robust collaboration with cosmetic surgeons and endocrinologist in the management of goiters improved our outcome.