What are the most serious complications after thyroid surgery?

Thyroid surgery can easily lead to various complications, such as wound bleeding or nerve damage, and some patients may also show hand and foot cramps or other symptoms of functional impairment, so more attention should be paid to care after surgical treatment.

1. Bleeding from wound

If there is swelling of the wound or excessive bleeding, surgery should be performed again to stop the bleeding.

2. Nerve damage

(1) Recurrent laryngeal nerve injury: Recurrent laryngeal nerve injury is mainly caused by direct injury during surgical operations, such as cutting, suturing, clamping or excessive traction. A few cases are caused by hematoma compression or traction of scar tissue. The former develops symptoms immediately during surgery, while the latter develops symptoms several days after surgery. The injuries caused by cutting and suturing are permanent; the injuries caused by clamping, traction or hematoma compression are mostly temporary injuries, which can generally be gradually recovered within 3 to 6 months after treatment. Hoarseness caused by unilateral recurrent laryngeal nerve damage can be improved by excessively adducting the healthy vocal cord toward the affected side; bilateral recurrent laryngeal nerve damage can lead to paralysis of the vocal cords on both sides, causing aphonia or severe breathing difficulties, requiring tracheotomy.

(2) Superior laryngeal nerve injury: This is usually caused by ligating or cutting the superior thyroid artery and vein, which are far away from the upper pole of the thyroid gland and are not carefully separated, resulting in ligation of a large bundle of surrounding tissue. Injury to the external branch can paralyze the cricothyroid muscle, causing the vocal cords to relax and the pitch to drop. Damage to the internal branches can cause loss of sensation in the laryngeal mucosa, making it easy for the throat to accidentally swallow or choke on water. The patient will usually recover on his own after treatment.

3. Hand and foot convulsions

It is caused by accidental removal of the parathyroid gland or insufficient blood supply. The blood calcium drops below 2.0mmol/L, with mild symptoms such as numbness of the face, lips, hands and feet, and severe symptoms such as convulsions in the limbs. Prevention should emphasize protecting the parathyroid gland safety zone during surgery to avoid accidental resection or loss of blood supply.

Treatment: Those with mild symptoms can take calcium supplements orally. In severe cases, 10-20 ml of 10% calcium gluconate should be injected intravenously during attacks. When the parathyroid gland is permanently damaged and the limb convulsions cannot be improved by calcium supplementation, fetal vascular thyroid-parathyroid transplantation to the inguinal area can be considered, which can have a good effect.

4. Dangerous appearance

It is often related to insufficient preoperative preparation and uncontrolled hyperthyroidism symptoms. Symptoms include postoperative high fever, rapid pulse, vomiting and mental symptoms, which usually occur within 36 hours after surgery and are serious.

Treatment: ① Oral administration of iodine or intravenous drip of 5-10 ml of sodium iodide (added to 500 ml of glucose solution); ② Application of hormones; ④ Others: application of sedatives, antihypertensive drugs, cardiotonic drugs, cooling, oxygen inhalation, etc.

5. Functional impairment

It is mostly caused by excessive thyroid removal or insufficient blood supply to the remaining thyroid, and often manifests as postoperative weakness and edema. T3 and T4 values ​​are persistently below the lower limit of normal values. Oral thyroxine can be used for treatment.