Title : Evaluating thyroidectomies performed at a single NHS trust; outcomes and considerations
Abstract:
Background: Around 22,000 thyroidectomies are performed annually in England. Common indications include FNA result (38%), compressive symptoms (24%) and thyrotoxicosis (19%). Recognised complications include pain, bleeding (re-operation), infection, vocal cord palsy (VCP) and voice change, and long-term calcium replacement.
Aim: To compare the outcomes of thyroidectomies performed within a single centre against the BAETS guidelines.
Method: A retrospective case note review of all thyroid surgeries performed by ENT surgeons within a single centre between 01/01/23 and 31/12/23 was performed.
Results: 62 thyroid surgeries were performed on 49 women and 8 men. 89% of the cases were primary surgeries. Commonest indications were compressive symptoms (35%) and FNA result (31%). Pre and post-operative laryngoscopy was performed in 71% and 89% of cases respectively, Adjusted calcium was checked within 12 hours post-operatively in 100% of total and completion thyroidectomies and in 12 patients post-hemithyroidectomy. Post-operative bleeding requiring re-operation occurred in 1.8% and post-operative wound infection in 5.3%. Long-term calcium supplementation was required in 3 patients, 4.8%. Post-operative VCP occurred in 1 patient at 12 months follow-up.
Conclusions: Comparatively, peri-operative laryngoscopy was above the national standard, however post-operative VCP at 12 months was below and long-term hypocalcaemia was higher (4.8% c.f 3.7%). Notwithstanding a smaller data set, valuable learning points remain:
All patients should have peri-operative laryngoscopy recorded as VCP may occur in 2.4% of patients pre-operatively and 2.7% post-operatively. Education on avoidance of unnecessary investigation post-hemithyroidectomy may improve patient experience. Implementation of a pre-operative vitamin-D check and post-operative 6-week thyroid function check may improve clinical management and outcomes.
