Thyroid Surgery - Risks and Complications

The thyroid gland sits in a pocket in the lower neck surrounded by a number of important structures including nerves and the parathyroid glands.

The nerves that control our voice are intimately associated with the voice box. Injury to these nerves can result in temporary or permanent voice hoarseness. Dr Sinclair utilizes continuous nerve monitoring of these nerves during surgery so that she can ensure that they are functioning at all stages during your surgery (see additional section on nerve monitoring for further details).  Rates of temporary hoarseness due to nerve injury are 0.2% and of permanent nerve injury, 0.1%. All patients have pre and post operative voice examinations.

Temporary limitations in pitch and projection of the voice and vocal fatigue with prolonged voice use are common after thyroid surgery and usually recover within 2 months. These minor voice changes are not due to nerve injury but due to the healing process itself causing inflammation in the tissues and muscles surrounding the voice box.

The parathyroid glands control calcium levels in the blood. During thyroid surgery the four parathyroid glands are carefully removed off the surface of the thyroid gland and left in your body. However the glands are delicate and often their function is disrupted for some days after the surgical procedure. Not uncommonly the parathyroid glands will not function after a total thyroidectomy. This can cause low blood calcium for people having a total thyroidectomy. When only one side of the thyroid gland is removed, the parathyroid glands on the other side function normally and low blood calcium is not an issue. If you have had a total thyroidectomy, Dr Sinclair will send you home on calcium tablets to be continued for the first week postoperatively. After one week, 90% of patients can cease their calcium as the parathyroid glands have regained normal function. 10% of patients will continue to require calcium for a longer duration. The risk of needing lifelong calcium supplements (with or without vitamin D supplements) after total thyroid surgery with Dr Sinclair is 1%.

There is a small risk of bleeding after thyroid surgery. If removing the thyroid leaves a large space in the neck, Dr Sinclair may place a drain tube that will come out the next day. If bleeding does occur after thyroidectomy, you may need a second operation to remove the blood so that it does not affect your breathing.

Additional uncommon risks include:

  • Infection <0.5%.
  • Seroma (fluid collection) 2% (higher for large thyroids)
  • Bruising 10% (higher with small incisions)
  • Needing thyroid tablets after removing half of thyroid 20%
  • Keloid scarring 5% in Asians, Indians, Africans
  • Anesthetic related risks
    • You will require general anaesthesia
    • This is given by a specialist anaesthetist.
    • Risk of a serious complication in a healthy person is very rare. Potential risks include:
  • Heart problems (death, heart attack, arrhythmias)
  • Lung problems (pneumonia, wheezing)
  • Blood clots (stroke, clots in leg veins or lungs)
  • Drug reactions (also possible with local anaesthetic)
  • Chipped teeth
  • Other unforeseen risks

You will have the chance to meet and ask any additional questions to your anesthetist prior to surgery.

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