Clinical and metabolic changes following complicated thyroid resection procedures.

UNLABELLED: Clinical and metabolic consequences of complicated thyroid resection procedures are rarely an object of complex analysis, and teams participating in treatment may have a very limited knowledge of them. The aim of the study was to assess clinical and metabolic consequences of complicated thyroid surgical procedures.

MATERIAL AND

METHODS

In the years 2002-2007, 756 patients underwent surgery due to non-neoplastic thyroid diseases. Sixty-nine (9.1%) patients experienced complications manifesting as vocal cord paralysis and/or hypoparathyroidism. Follow-up examination was conducted in a group of 42 persons, which amounted to 61% of patients who experienced complications following thyroid surgical procedures. Follow-up examination, comprising assessment of morphotic blood elements, electrolyte, lipid and parathormone blood concentrations, thyroid hormone activity, respiratory function, vocal cord mobility, bone mineralization and ultrasound examination of the pocket left after thyroid resection, was conducted after the mean period of 43 months following surgery.

RESULTS

In the analyzed group, no significant differences in plasma electrolyte content were found (sodium, potassium, magnesium, calcium and phosphorus ions). In the group of patients with chronic hypoparathyroidism, no hypophosphatemia was observed, and there were no reports of concomitant nephrolithiasis or cataract. Increased cholesterol concentration was observed in the group of patients with chronic hypoparathyroidism and without hypoparathyroidism (p = 0.07). In 35% of patients with chronic vocal cord paralysis, abnormal results of spirometry tests were obtained. In the group of patients with chronic hypoparathyroidism, densitometry examination revealed higher T-score values compared with patients with transient hypoparathyroidism and vocal cord paralysis (p = 0.07). No bone mineralization disorders manifesting as pathological fractures were noted.

CONCLUSIONS

The knowledge of clinical and metabolic consequences of complicated thyroid surgical procedures, due to their complexity, may be very limited among the members of both surgical teams and teams involved in management of complications. Development of a complication following thyroid surgery may be associated with significant homeostasis disorders, especially as regards calcium-phosphate metabolism, the skeletal system and the respiratory system. Such disorders can manifest long after the disease onset, only properly intensified and long-term management allows limitation of their extent.