Risk Factors Associated with Post-Thyroidectomy Complications in Different Types of Thyroid Surgeries – 120 Cases

Open Access

Abstract

Background: Thyroid surgery is commonly performed for benign and malignant disease. Post-thyroidectomy complications—particularly hypocalcemia and recurrent laryngeal nerve (RLN) injury—remain clinically significant and affect patient outcomes. This study aimed to evaluate early and late complications after different thyroid surgeries and identify associated risk factors in 120 consecutive cases. Methods & Materials: A prospective observational study was conducted on 120 adult patients undergoing thyroid surgery at a National Institute of ENT, Tejgaon, Dhaka, Bangladesh, from January to June 2025. Procedures included hemithyroidectomy, total thyroidectomy, and completion thyroidectomy, with some cases involving central neck dissection. Demographic, clinical, operative, and pathological data were collected. Primary outcomes included overall complication rate, transient and permanent hypocalcemia, transient and permanent RLN palsy, hematoma requiring reoperation, wound infection, and need for tracheostomy. Univariate (χ², t-test) and multivariate logistic regression analyses identified independent predictors of complications. Significance was set at p<0.05. Results: Mean age was 44.7±13.6 years; 68.3% were female. Surgeries included total thyroidectomy (46.7%), hemithyroidectomy (33.3%), and completion thyroidectomy (10%). Overall complication rate was 30.8%. Transient hypocalcemia occurred in 18.3% and permanent in 2.5%. Transient RLN palsy occurred in 6.7% and permanent in 1.7%. Hematoma requiring reoperation occurred in 3.3%. Multivariate analysis showed independent predictors of any complication: total thyroidectomy (OR 3.2), central neck dissection (OR 4.5), reoperation (OR 5.1), and low surgeon case volume (<50/year) (OR 2.8). Total thyroidectomy and central neck dissection strongly predicted hypocalcemia; reoperation and large goiter/thyroiditis were associated with RLN palsy. Conclusion: Extensive procedures, reoperations, and lower surgeon experience increase postoperative complications. Careful patient selection, meticulous surgical technique, and parathyroid preservation can reduce risks.