Complications From Thyroid Surgery

Major postoperative complications include wound infection, bleeding, airway obstruction (compressing hematoma, tracheomalacia), hypocalcemia, thyroid storm (uncommon, usually associated with Grave’s disease) and recurrent laryngeal nerve injury.

Incidence is 3-5%. Surgery can lead to trauma to the parathyroids, devascularization of the glands with resultant ischemia, or inadvertent excision of these small structures. Hypoparathyroidism with subsequent decreased production of parathyroid hormone leads to decreased serum calcium. Acute hypocalcemia generally presents at 24-48 hours as laryngeal stridor and airway obstruction. First symptoms are usually tingling in the lips and fingertips. Additional findings may develop, including carpopedal spasm, tetany, laryngospasm, seizures, QT prolongation and cardiac arrest. Chvostek’s sign is facial contractions elicited by tapping the facial nerve in the per-auricular area. Trouseau’s sign is carpal spasm on inflation of a blood pressure cuff. CPAP is often effective for associated airway compromise, and 1 gram of calcium gluconate given slowly usually alleviates symptoms.