The Influence of Preoperative Thyroid Gland Volume On Intraoperative Time and Postoperative Complications for Total Thyroidectomy Patients

Abstract

Objective: To determine the influence of preoperative thyroid gland volume on intraoperative time and postoperative complications for total thyroidectomy patients in a militaty tertiary hospital.

Design: A cross-sectional analysis for data collected retrospectively from 106 consecutive patients who underwent thyroid surgery for various thyroid diseases at King Fahad Armed Forces Hospital in Saudi Arabia, between January 2015 and December 2019.

Methods: A total of 106 patients (96 Female = 90.6% and 10 males = 9.4 %). Thyroid gland volumes were calculated preoperatively using ellipsoid model. FNA was done per American thyroid association guidelines. The patients underwent total thyroidectomy for benign and malignant thyroid conditions. The intraoperative time was measured starting from the skin incision till wound closure. Patients were followed for perioperative complications. The intraoperative time was correlated with preoperative ultrasonographic sizes of the thyroid glands. Independent sample t-Test done to compare mean US volumes in patients with complications and patients without complications.

Results: The average thyroid gland volume was 43.48 ml the largest volume was 189.454 ml and the lowest volume was 1.46 ml. The average intraoperative time was 2 hours with longest time was 4 hours in a case with thyroid gland volume of 159.9 ml and the shortest intraoperative time was 1 hour and 1 minute in a case with thyroid gland volume of 58.44 ml. Total number of complications was 14 =13.2%. 1 case (0.9%) of expanding hematoma which required surgical drainage on a patient with thyroid gland volume of 34.59 ml, 7 cases (6.6%) of permanent hypocalcemia observed on patients with thyroid gland volumes of (9.16,14.21,19.81, 31.4, 37.57, 53.8, 159 ml). 4 cases (3.8%) of transient unilateral vocal fold immobility observed in patients with thyroid gland volumes of (11.55, 12.94, 26.98, 74.81ml) and 2 cases (1.9 %) of transient bilateral vocal folds immobility observed in patients with thyroid gland volumes of (60.53, 82.99 ml).

Conclusion: The larger preoperative thyroid gland volume the longer operative time. Preoperative thyroid gland volume showed no significant influence on perioperative complications. Hence reviewing preoperative ultrasonographic thyroid gland volume may help the surgeon and operative staff preparations for larger cases.