Complications of Thyroid surgery:

Postoperative bleeding
The incidence of bleeding after thyroid surgery is low (0.3-1%), but an unrecognized
or rapidly expanding hematoma can cause airway compromise and asphyxiation.
Patients present with neck swelling, neck pain, and/or signs and symptoms of
airway obstruction (eg, dyspnea, stridor, hypoxia).
Injury to the recurrent laryngeal nerve
Recurrent laryngeal nerve (RLN) injury results in true vocal-fold paresis or paralysis.
Deliberate intraoperative identification and preservation of the RLN minimizes the
risk of injury.
Hypoparathyroidism
Hypoparathyroidism can result from direct trauma to the parathyroid glands,
devascularization of the glands, or removal of the glands during surgery.
Postoperative hypoparathyroidism, and the resulting hypocalcemia, may be
permanent or transient. Hypocalcemia after thyroidectomy is initially asymptomatic
in most cases.
Thyrotoxic storm
Thyrotoxic storm is an unusual complication that may result from manipulation of
the thyroid gland during surgery in patients with hyperthyroidism. It can develop
preoperatively, intraoperatively, or postoperatively. Signs and symptoms of
thyrotoxic storm are as follows:

Anesthetized patients: Evidence of increased sympathetic output (eg,

tachycardia hyperthermia)
Awake patients: Nausea, tremor, and altered mental status
Cardiac arrhythmias may also occur
Progression to coma in untreated patients

Injury to the Superior Laryngeal Nerve

The external branch of the superior laryngeal nerve (SLN) is probably the nerve
most commonly injured in thyroid surgery, with an injury rate estimated at 0-25%.
Trauma to the nerve results in an inability to lengthen a vocal fold and, thus,
inability to create a high-pitched sound; this may be career-threatening for singers
or others who rely on their voice for their profession. Speech therapy is the only
treatment.
Infection

Currently, postoperative infection occurs in less than 1-2% of all thyroid surgery
cases. Sterile surgical technique is the key to prevention; routine use of
perioperative antibiotics has not proven to be beneficial.
Hypothyroidism
Hypothyroidism is an expected sequela of total thyroidectomy. Measurement of TSH
levels is the most useful laboratory test for detecting or monitoring of
hypothyroidism in these patients.