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Complications After Thyroid Surgery

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Updated June 03, 2014

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Thyroid surgery is considered extremely safe. Some of the more common side effects -- for example, pain when swallowing, and neck stiffness -- are discussed in greater depth in the article on Recuperating After Thyroid Surgery .

The risk of more significant complications are higher for total thyroidectomy as compared to subtotal thyroidectomy. Complications are also more likely with surgeons who have less experience performing thyroid surgery, so it's important to make sure that you have an experienced thyroid surgeon. Find out more in the article about Choosing a Top Thyroid Surgeon.

Hypoparathyroidism and Hypocalcemia

Hypoparathyroidism is underfunctioning of the parathyroid glands. The function of the parathyroids is to control your body's calcium levels. If the parathyroids are damaged or nicked during surgery, this trauma can cause temporary or permanent shutdown, which results in a lowered calcium level, called hypocalcemia.

Permanent hypoparathyroidism is rare, but transient hypoparathyroidism affects approximately 7 percent of patients. Some patients are, however, at a higher risk of hypoparathyroidism and hypocalcemia. The risk factors include:

  • surgery for hyperthyroidism or Graves' disease
  • surgery for multinodular goiter
  • full thyroidectomy, rather than a lobectomy
  • central neck dissection for thyroid cancer, which involves removing lymph nodes and lymph tissue around the thyroid
  • a repeat thyroid surgery
Discuss your risk factors for hypoparathyroidism with your surgeon, and be sure to mention any potential symptoms you experience. Symptoms, which usually appear the first week after surgery, can include:
  • numbness and tingling feeling around your lips, hands, and the bottom of your feet
  • crawly feeling in your skin
  • muscle cramps and spasms
  • bad headaches
  • anxiety
  • depression
These symptoms usually start in the day or two after surgery. It is rare for these symptoms to appear after 72 hours.

Your doctor will typically recommend temporary calcium supplementation. Ask your doctor if you should have calcium tablets on hand before the surgery, and how you should proceed if you have symptoms.

If you take calcium for hypocalcemia symptoms, tingling and numbness usually goes away within a half-hour after taking calcium. While practitioners usually recommend that you take calcium as often as needed to control your symptoms, be sure to discuss this with your doctor beforehand.

The hypocalcemia should disappear in 7 to 10 days. If it doesn't, tell your physician. If you are one of the few patients who develops permanent hypoparathyroidism, the treatment is calcium and vitamin D, for life.

If the parathyroid glands cannot be preserved during a total thyroidectomy, some surgeons will cut the glands into small pieces and then inject them into a muscle -- the shoulder, for example -- where the gland piece can function to regulate the body's calcium level.

Laryngeal Nerve Damage

In an estimated 1 out of every 250 thyroid surgeries, damage is done to the laryngeal nerves, the nerves that control the voice. The primary symptoms include:
  • Difficulty projecting the voice
  • Hoarse voice
  • Voice fatigue
  • Decreased vocal range
Usually, voice changes are temporary, so the voice will return to normal within a few weeks; permanent changes are rare. Use of nerve monitors during surgery has become more common, however, as these surgical devices can greatly reduce the risk of damage. For an overview, read this Wall Street Journal article (PDF), "Taking Steps to Curb Vocal-Chord Damage from Thyroid Surgery."

Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.

References:

Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.

Columbia Presbyterian Thyroid Center Web Site, Online

Erbil Yesim., et. al. "Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery" Clinical Otolaryngology 32 (1), 32-37. Online

Erbil, Yeşim. "The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter" Langenbeck's Archives of Surgery, Volume 391, Number 6, November 2006 , pp. 567-573(7) Online

Gaujoux, S. et. al. "Extensive Thyroidectomy in Graves' Disease, "Journal of the American College of Surgeons, Volume 202, Issue 6, Pages 868-873, Online

Harness, Jay K. et. al. "Total thyroidectomy: Complications and technique," World Journal of Surgery, Volume 10, Number 5 / October, 1986, Online

Ku, Chun-Fan et. al. "Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease," ANZ Journal of Surgery, Volume 75 Issue 7 Page 528-531, July 2005 Online

Lal, Geeta et. al. "Should Total Thyroidectomy Become the Preferred Procedure for Surgical Management of Graves' Disease?" Thyroid, Jun 2005, Vol. 15, No. 6 : 569 -574 Online

Moreno, Pablo, et. al. "Subtotal Thyroidectomy: A Reliable Method to Achieve Euthyroidism in Graves' Disease. Prognostic Factors," World Journal of Surgery , Volume 30, Number 11, November 2006 , pp. 1950-1956(7) Online

Razack, Mohamed S. et. al. "Total thyroidectomy for Graves' disease," Head and Neck, Volume 19, Issue 5 , Pages 378 - 383, Online[/line]

Rosato, L, et. al. ."Complications of total thyroidectomy: incidence, prevention and treatment"Chir Ital. 2002 Sep-Oct;54(5):635-42

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