Complications after total thyroidectomy in correlation with histopathological and hormonal findings

Abstract

Introduction/Objective Total thyroidectomy (TT) is frequently performed in head and neck surgery and is considered a relatively straightforward procedure, yet it is still associated with a number of complications. This study aimed to examine the role and significance of TT in the occurrence of postoperative complications in correlation with histopathological (HP) and endocrinological findings.

Methods A cross-sectional study was conducted involving 90 patients in the University Clinical Center of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina who underwent the thyroid gland surgery 2022–2024. Preoperatively, hormonal analyses, thyroid ultrasound examination, and endovideolaryngoscopy were performed. TT was performed in all patients. Postoperatively, HP diagnostics, control hormonal tests, and endovideolaryngoscopy were performed.

Results Vocal fold paralysis (VFP) was reported by 11 (12.2%) patients. HP analysis showed that goiter was the leading cause in 37 (41.1%) patients, followed by follicular adenoma in 25 (27.8%) and papillary carcinoma in 18 (20%); other causes were present in the remaining 10 (11%). Regarding endocrinological complications, hypocalcemia was present in 67 (74.4%) patients, and elevated parathyroid hormone levels in four (4.4%) patients.

Conclusion VFP and hypocalcemia represented the most common postoperative complications after TT, particularly in patients with HP-diagnosed goiter, follicular adenoma, or papillary thyroid carcinoma. These findings may help identify older patients who are at increased risk of TT-related complications that could significantly impair their quality of life.

Keywords: hypocalcemia; thyroid gland diseases; vocal fold paralysis