POST-OPERATIVE MORBIDITY: COMPARISON OF PRIMARY SURGERY VERSUS RE-OPERATIONS IN THYROID - 10 YEAR RETROSPECTIVE STUDY IN A TERTIARY CARE TEACHING HOSPITAL IN RURAL SOUTH INDIA

Vergis Paul, Nevil C. Philip*, Ramu R. and Devipriya S.

ABSTRACT

Pathologies of thyroid gland, requiring surgical correction are on the rise. The surgeries on thyroid gland can be varied ranging from total thyroidectomy to various types where the entire gland is not removed. There are many who follow the practice of a less than total thyroidectomy for benign pathologies and follicular neoplasms of thyroid. Literature has showed the incidence of occurrence of malignancies and goiter in thyroid remnant, necessitating the need for re-operation in patients with primary less than total thyroid surgery. We did a retrospective study to introspect on thyroid surgeries done in our hospital in the past 10 years to know the trend followed in our hospital and to know the effects of different types of thyroid surgeries and the morbidities faced by patients undergoing reoperations. This is a cross-sectional study by retrospective chart analysis of all thyroidectomy cases from the past 10 years in our institute. Institutional review board and ethics committee approval was obtained. Data was analysed using SPSS v.25. 1094 thyroid surgeries were performed in the last 10 years, of which 1033 were primary surgery, and 61 were re-operations. There was a statistically significant increase in the occurrence of transient recurrent nerve palsy and transient hypocalcaemia in re-operations when compared to primary thyroid surgery. All the other parameters except permanent hypocalcaemia had higher rate in re-operations, though not statistically significant. 26 out of the 61 re-operations were done as the post-operative biopsy of the primary surgery showed malignancy while 30 were done due to occurrence of goitre in thyroid remnant. 3 were due to the occurrence of malignancy in thyroid remnant and 2 due to tumour recurrence. These findings make us feel whether we should deal all surgical pathologies of thyroid gland with total thyroidectomy. We know that this is not the teaching, but looking at the rate of morbidity in re-operations and the incidence of malignancy being detected post-operatively and surgical pathology developing in remnant thyroid, we feel the need for total thyroidectomy. There is a scope to revisit and rethink the surgical management of thyroid pathologies based on multicentric analysis.

Keywords: Thyroid, Thyroidectomy, Post-operative complications, Re-operations, Surgery.