An Audit of the Procedure of Open Thyroidectomy at A Tertiary Care Centre
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ORIGINAL ARTICLE
An Audit of the Procedure of Open Thyroidectomy at A Tertiary Care Centre Rabia Monga1 • Anupam Kanodia1 • Smile Kajal1 • David Victor Kumar Irugu1 Kapil Sikka1 • Alok Thakar1 • Rakesh Kumar1 • Suresh C. Sharma1 • Shipra Agarwal2 • Shamim Ahmed Shamim3 • Hitesh Verma1
•
Received: 19 June 2020 / Accepted: 31 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract We plan to evaluate the various variables associated with the complications of thyroidectomy performed at our department in the last 5 years. Medical records of the patients who underwent thyroidectomy during 2014–2018 were collected. Complications of hypocalcemia and recurrent laryngeal nerve palsy were analysed in terms of the demography, cytopathology and the extent of surgery. Student’s t-test, Mann–Whitney U-test, Fisher exact test and chi square test were applied to look for any significant & Hitesh Verma [email protected] Rabia Monga [email protected] Anupam Kanodia [email protected] Smile Kajal [email protected] David Victor Kumar Irugu [email protected] Kapil Sikka [email protected] Alok Thakar [email protected]
associations. P value \ 0.05 was considered significant. 123 patients were analysed (87 females, 38 males). Mean age was 38.3 years (range 11–71 years). Most common cytopathology was papillary carcinoma thyroid (Bethesda VI) - 43/123 (35%). 107 of these 123 patients underwent primary surgery, 10 underwent revision surgery while 6 underwent completion thyroidectomy. Seven patients incurred RLN palsy out of which 3 were temporary. RLN palsy was seen in only malignant cases (p \ 0.05). Incidence was higher in T4a stage (p \ 0.05). However, it had no association with a simultaneous central or lateral neck dissection. Hypocalcemia was seen in 22 patients (17.8%), out of whom 9 patients developed permanent hypocalcemia. It was seen significantly higher in patients undergoing central neck dissection (p \ 0.05) and in malignant thyroid lesions (p \ 0.05). Gender, age and the cytopathology had no bearing on RLN palsy and hypoparathyroidism. Malignant thyroid lesions had a significantly higher incidence of RLN palsy and hypoparathyroidism. A thorough anatomical knowledge can reduce the incidence of these complications. Keywords Thyroidectomy Recurrent laryngeal nerve Hypocalcemia Hypoparathyroidism
Rakesh Kumar [email protected] Suresh C. Sharma [email protected] Shipra Agarwal [email protected] 1
Present Address: Department of ENT and Head and Neck Surgery, AIIMS, New Delhi 110029, India
2
Department of Pathology, AIIMS, New Delhi, India
3
Department of Nuclear Medicine, AIIMS, New Delhi, India
Introduction The incidence of nodular thyroid disease; benign or malignant is quite high. Detailed clinical assessment, fine needle aspiration cytology (FNAC) and relevant laboratory investigations are the standard ways to reach a diagnosis [1]. Local compressive symptoms and cosmetic reasons are the leading indications for thyroidectomy in a benign lesion. The type of
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