All of the following are complications of total thyroidectomy, EXCEPT:
ANSWER: (C) HypercalcemiaREF: Bailey 25th ed page 790, Sabiston 18th ed chapter 36, Washington manual of surgery 5th ed page 347 COMPLICATIONS OF TOTAL THYROIDECTOMYBleedingand wound hematomasA tension haematoma deep to the cervical fascia is usually due to reactionary haemorrhage from one of the thyroid Arteries.Require immediate re-exploration This is very rarely due to collapse or kinking of the trachea (tracheomalacia). Most cases are caused by laryngeal oedema. The most important cause of laryngeal oedema is a tension haematoma.TransientHypocalcemiaCommonly occurs 24 to 48 hours after thyroidectomy but infrequently requires treatment.Markedly symptomatic or serum calcium < 7 mg/dL are given 1-2 ampules (10 to 20 mL) of 10% calcium gluconate IV over 1 to 2 min, followed by temporary' oral calcium carbonate (500 mg orally TDS).More prolonged IV replacement by mixing 6 ampules of 10% calcium gluconate in dextrose 5% in water (D5W), 500 mL, for infusion at 1 mL/kg'hour.PermanentHypocalcemiaPermanent hypoparathyroidism is uncommon after total thyroidectomy. Incidence of permanent hypoparathyroidism is < 1%. Present dramatically 2-5 days after operation. Normal parathyroid tissue removed or devascularized at the time of total thyroidectomy must be minced into 1 x 3-mm fragments and autotransplanted into individual muscle pockets in the sternocleidomastoid muscle to maximize the chances that the patient will not develop postoperative hypoparathyroidismRLN injuryUnilateral RLN injury causes hoarseness, and bilateral injury compromises the airway, necessitating tracheostomy. Unilateral or bilateral recurrent nerve paralysis will not cause immediate postoperative respiratory obstruction unless laryngeal oedema is also present but it wall aggravate the obstruction. RLN palsy rate of 1.8% at 1 month declining to 0.5% at 3 months for first-time operations. RLN can be repaired primarily or with a nerve graftSuperior laryngeal nerve injuryVoice changes, huskiness, poor volume voice fatigue, and inability to sing at higher rangesThyroidinsufficiencyTnis results from a change in the autoimmune response, from stimulation to destruction of the thyroid cells.Thyrotoxic crisis (storm)It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy and is now extremely rare. Symptomatic & supportive treatment is for dehydration, hyperpyrexia & restlessness.Specific treatment is with carbimazole 10-20 mg 6-hourly, Lugol's iodine 10 drops 8-hourly by mouth or sodium iodide 1 g IV. Propranolol TV (1-2 mg) or orally (40 mg 6-hourly) will block P-adrenergic effects.WoundinfectionCellulitis requiring prescription of antibiotics, often by the general practitioner, is more common than most surgeons appreciate. A significant subcutaneous or deep cervical abscess is exceptionally rare and should be drainedHypertrophicor keloid scarThis is more likely to form if the incision overlies the sternum and in dark-skinned individuals. Intradermal injections of corticosteroid should be given at once and repeated monthly if necessary.StitchgranulomaThis may occur with or without sinus formation and is seen after the use of nonabsorbable, particularly silk, suture material. Absorbable ligatures and sutures must be used throughout thyroid surgery. Skin staples , if used, can be removed safely in less than 48 hours because the skin closure is supported by the platysma stitch.
Hemorrhage
Hoarseness
Hypercalcemia
Airway obstruction
Surgical Approaches to the Thyroid