Laryngeal Complication After Total Thyroidectomy

Abstract

Background: Thyroidectomy is commonly performed for large goiters and thyroid malignancies. Laryngeal complications, primarily due to recurrent laryngeal nerve injury, are a frequent concern. The incidence of temporary and permanent RLN paralysis varies based on surgical type and different studies. Methods: The study is a prospective observational study carried out in National Institute of ENT, Tejgaon, Dhaka. A total of 60 patients, fulfilling preoperative inclusion criteria, were recruited from the period of March 2020 to August 2020. All 60 patients underwent total thyroidectomy with or without neck dissection. Follow-up of these patients was for a period of one year (up to 31st August 2021) after surgery. All patients between the ages of 18 and 65 who are willing to participate in the study are eligible for inclusion. Results: In the study, 65% of patients were female, with a mean age of 43.15±12.2 years. The most common conditions were multinodular goiter (33.3%), Graves’ disease (21.7%), thyroid carcinoma (15%), and Hashimoto’s disease (8.3%). Transient unilateral RLN injury occurred in 15% of cases, bilateral vocal cord paralysis in 3.3%, and permanent injury in 1.7%. RLN injury incidence was 12%, significantly higher in ages 39-58 (11.6%, p=0.034), primary vs. secondary operations (15% vs. 5%, p=0.002), subtotal vs. total thyroidectomy (16.7% vs. 3.3%, p=0.024), non-identification of RLN (8.3% vs. 1.6%, p=0.0443), and malignant vs. benign disease (8.3% vs. 11.6%, p=0.004). No significant association was found with gender. Conclusion: Total thyroidectomy is a safe procedure with a low RLNP risk for Graves' disease, thyroid cancer, and Hashimoto's disease. However, RLNI risk is higher in total thyroidectomy, re-operation, non-identification of RLN, and older age.