Endocrine Abstracts (2004) 7 P306

Audit of thyroid surgery in a district general hospital

U Srinivas Shankar2, T Jordan2, J Plant2, R Movva2, GE Foster1, MK Rutter2, DL Ewins2 & RC Worth2

1Department of Surgery, Countess of Chester Hospital NHS Trust, Chester, UK.; 2Department of Endocrinology, Countess of Chester Hospital NHS Trust, Chester, UK.

Aim: To assess the outcome of thyroid surgery in a District General Hospital.

Methods: Retrospective study of thyroid surgery done over a 3-year period(1999-2002). Indications for surgery, pre and postoperative thyroid status, extent of surgery, post operative complications and post operative histology were evaluated.

Results: 124 patients underwent surgery for thyroid disease. 90 % were female and 10 % male, median age of 52 years (20-87). Common indications for surgery were pressure symptoms (33%, n = 41), suspected malignancy (32% n = 40) and relapsed Graves'(23%,n=29). Other indications included enlarging goitre (10%, n=12), Cosmetic reasons (6%, n=7), Hyperthyroidism (5%, n=6), and Retrosternal goitre (1.5 %, n=2). 86 patients (69%) were Euthyroid, 34 (28%) Hyperthyroid, 4(3%) Hypothyroid at presentation. Fine Needle Aspiration Cytology (FNAC) was done in 37 patients (30%). It was indeterminate in 66%. Malignant pathology and suspicious pathology was found in one patient each.Commonest surgery done was Sub Total Thyroidectomy in 44 patients (35%), Hemithyroidectomy in 33 (27%), Lobectomy in 28 (23%), and Total Thyroidectomy in 11 (9%). Preoperative Indirect laryngoscopy was done in 81(65%). Postoperative complications were minor ,observed in 27 patients(22%).Hypocalcaemia was recorded in 16 patients(13 %). It was asymptomatic in half of these patients. Wound infection 3 (2.4%), local haemorrhage 4 (3.2%) and transient recurrent laryngeal nerve palsy 1 (0.8%) were noted. Postoperative thyroid status was Euthyroid in 81 patients (66 %), Hypothyroid in 39 (31%) and Hyperthyroid in 4(3 %). Postoperative histology was Malignant in 10 (8 %). This included Papillary carcinoma (6), Follicular carcinoma (2), Undifferentiated thyroid carcinoma (1) and Lymphoma (1).

Conclusion: The study reveals a low incidence of complications following thyroid surgery. The study also reveals minimal morbidity in patients under going Total or Sub Total Thyroidectomy for benign thyroid disease affecting the whole gland.

Careful preoperative evaluation helps in achieving a satisfactory outcome of thyroid surgery. Thyroid surgery is safe to be done in a District General Hospital.

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