Total Thyroidectomy Not Associated With Substantial Increase in Complications as Compared to Standard Treatment

Thyroidectomy as a treatment for hyperthyroidism has been reported to be a safe and effective option for hyperthyroidism, however, bleeding and clotting during the surgery has always been a concern. French researchers writing in JAMA Otolaryngology–Head & Neck Surgery report the results of a nonrandomized clinical trial in which patients with preoperative hyperthyroidism did not have statistically significantly more complications after total thyroidectomy as compared to patients who received preoperative anti-thyroid drugs.

The study, which was conducted between March 2012 to June 2014 and is based on a sample from the FOThyr study, included 1,250 patients (mean age 51 years, 997 women) from 14 hospitals in France. Of these, 255 patients had hyperthyroidism and 995 patients had euthyroidism.

The results were consistent with other studies with relatively few patients experiencing complications from the surgery. Specifically, after the surgery, 130 of 1,250 patients were diagnosed with abnormal vocal cord mobility (102 of 995 patients (10.3%) in the euthyroidism group and 28 of 255 patients (11.0%) in the hyperthyroidism group. Twelve patients were diagnosed with recurrent nerve palsy (10 patients in the euthyroidism group and 2 patients (0.8%) in the hyperthyroidism group (difference, 0.22%; 95% CI, −0.01% to 0.02%).

Postoperative hypocalcemia was diagnosed in 250 patients (20.0%), representing 196 patients (19.7%) in the euthyroidism group and 54 patients (21.2%) in thehyperthyroidism group (difference, 1.50%; 95%CI,−0.08% to 0.04%). Definitive hypocalcemia was diagnosed in 25 patients (2.0%), representing 19 patients (1.9%) in the euthyroidism group and 6 patients (2.4%) in the hyperthyroidism group (difference, 0.48%; 95% CI, −0.03% to 0.02%).

“In the present study, preoperative hyperthyroidism was not associated with substantial increases in the incidence of complications (neither postoperative nor definitive hypocalcemia, recurrent nerve palsy, or hematoma) after total thyroidectomy among patients who received preoperative anti-thyroid drugs. These morbidity results may be surprising, given that one would expect a substantial difference between patients with preoperative hyperthyroidism and those with euthyroidism,” the authors wrote.

Among the limitations for this study, which was published as a research letter, included the FOThyr study itself which was not designed to assess morbidity, but to evaluate only the 6-month clinical efficacy and cost-effectiveness of using ultrasonic scissors as compared to conventional hemostasis for thyroidectomy. Secondly, data on thyroid-stimulating hormone, triiodothyronine hormone, or thyroxine hormone levels were not collected on the day of surgery, only once at the preoperative consultation. Without that data, the effectiveness of preoperative treatments could not be assessed.

Reference 

Maxime Gerard, MD; Antoine Hamy, MD; Jean-Christophe Lifante,MD, PhD; et al. “Comparison of Morbidity After Total Thyroidectomy Among Adult Patients With andWithout Preoperative Hyperthyroidism,” JAMA Otolaryngology–Head & Neck Surgery. Published online March 18, 2021.