Thyroid Surgery Complications More Common Than Reported

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As more thyroid cancer is being diagnosed, the result is that more thyroid surgeries—known as thyroidectomies—are being performed. While the rate of complications after thyroid surgery is thought to be fairly small, a study has found that the rates may be significantly higher than previously reported. The research also showed that several groups are at greater risk of complications in the year after thyroid surgery.

To date, most of the studies on complications after thyroid surgery were conducted at specific hospitals or medical centers, many of which do a high volume of thyroid surgeries. High-volume surgeons and surgery centers that perform large numbers of thyroidectomies per year have been shown to have significantly lower complication rates.

The 2017 multi-center study looked at both high-volume and low-volume surgeons, hospitals, and surgery centers. The results, reported on in the Journal of Clinical Endocrinology and Metabolism, looked at almost 28,000 patients who had thyroid surgery for differentiated or medullary thyroid cancer, evaluated over a 13-year period.

The Research Findings

The researchers found:

  • A total of 1,820 (6.5 percent) patients developed a variety of post-operative complications, including fever, infection, hematoma, cardiopulmonary events, and thromboembolic events (blood clots)
  • A total of 3,427 (12.3%) developed thyroid surgery-specific complications including hypoparathyroidism/hypocalcemia (low calcium levels due to damage to the parathyroid glands), and paralysis of or damage to the laryngeal nerves and vocal cords

The complication rates from thyroid surgery were significantly higher in three groups:

  • Patients who were over the age of 65, who were three times more likely to experience complications than those under the age of 65 (A total of 10 percent of older patients developed general complications and 19 percent had thyroid specific complications. For those under 65, the rates were 3 percent and 6 percent, respectively)
  • Patients who had other health conditions, known as comorbidities
  • Patients with more advanced thyroid cancer, who had the highest rate of complications at 23 percent

According to lead study author, Maria Papaleontiou, MD of Michigan Medicine:

That 12 percent of patients overall had thyroid surgery specific complications is concerning. Most of our surgeons quote a 1 to 3 percent rate. This is quadruple what we had thought. Thyroidectomy is considered a fairly safe operation in general, but some populations are more vulnerable and need extra attention in pre- and post-operative care. 

What Does This Mean for Patients?

Senior study author Megan Haymart, MD of Michigan Medicine said:

When we work with patients to treat thyroid cancer, we're always balancing benefits and risks. This study shows there are more complications from surgery for thyroid cancer than expected. It suggests an opportunity to educate both patients and providers to decrease complications and improve outcomes.

This research has a number of implications for patients as far as opportunities to reduce complications.

  1. If you fall into one of the three risk groups—over 65, other health conditions, or advanced cancer—you should consider seeking out and having surgery at a facility that does a high-volume of thyroid surgeries, and with a surgeon that has expertise in thyroid surgery. (Note that the majority of thyroid surgeries in the U.S. are done by low-volume surgeons.)
  2. Be sure to discuss the signs and risks of hypoparathyroidism and hypocalcemia with your surgeon, and be aware of the symptoms after surgery.
  1. Discuss the need for surgery with your physician. According to Dr. Haymart, “Conversations about limiting surgery for those with low-risk disease may be appropriate. Even in low-risk patients, the risk of vocal cord paralysis is still 2 percent and the risk of hypoparathyroidism is 8 percent. This is higher than we'd like to see. Are there options to do less extensive surgery for these patients? If the cancer control benefits are similar but the risks of long-term complications would be less, we need to provide patients with this option."

A Word From Verywell

According to New York's Columbia-Presbyterian Hospital, one of the nation's top thyroid surgery centers, an experienced thyroid surgeon—one who is likely to result in lower complication rates for your surgery—has done more than 1,000 thyroid and/or parathyroid surgeries in his or her career.

According to the American Thyroid Association: 

In general, thyroid surgery is best performed by a surgeon who has received special training and who performs thyroid surgery on a regular basis. The complication rate of thyroid operations is lower when the operation is done by a surgeon who does a large number of thyroid operations each year. Patients should ask their referring physician where he or she would go to have a thyroid operation or where he or she would send a family member.​​​

To find a high-volume, experienced thyroid surgeon, you may also want to check out our tips on how to find a top thyroid surgeon.

Sources:

American Thyroid Association. "Thyroid Surgery." Online: http://www.thyroid.org/thyroid-surgery/

Papaleontiou M, Hughes DT, Guo C, Banerjee M, Haymart MR. Population-Based Assessment of Complications following Surgery for Thyroid Cancer. The Journal of Clinical Endocrinology & Metabolism, 2017; DOI: 10.1210/jc.2017-00255 Online: https://academic.oup.com/jcem/article-abstract/doi/10.1210/jc.2017-00255/3778176/Population-Based-Assessment-of-Complications?redirectedFrom=fulltext

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