Complications following thyroidectomy for benign thyroid diseases and their correlation with clinical, anatomical, and biochemical parameters

Background: Hypocalcemia and recurrent laryngeal nerve (RLN) palsy are common complications following thyroidectomy. The study was designed to assess the effect of preoperative clinical and biochemical features and the intraoperative anatomical features on the rate of complications following total thyroidectomy (TT) for benign thyroid disease. Materials and Methods: The prospective observational study was conducted on patients undergoing TT for benign thyroid diseases. All patients underwent complete assessment followed by the estimation of thyroid function (free T4 and thyroid-stimulating hormone). Ultrasound imaging of the neck and guided aspiration from the suspicious area for cytology were performed routinely. All patients were followed for minimum 6 months. Parameters used for the analysis included demographic features, feel of the gland, presence of adhesions to surrounding soft tissue, presence of retrosternal extension, and anatomical features of laryngeal nerves and parathyroid glands. Results: One hundred and twenty-five eligible candidates were included in the study and temporary hypocalcemia and temporary RLN palsy occurred in 48 (38%) and 9 (6.5%) patients, respectively. None of the patients had permanent complications. Failure to identify all four parathyroids was associated with a higher incidence of hypocalcemia (P < 0.001). Anatomical variation of RLN such as prelaryngeal branching and anterior relation to inferior thyroid artery were associated with a higher incidence of RLN palsy (P < 0.001). Conclusion: Meticulous surgical dissection and thorough knowledge of anatomy prevent the development of both hypocalcemia and RLN palsy in TT for benign thyroid disorders.