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Effect of complicated thyroid surgical procedures on personal and professional life of patients

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Sławeta N., Głuszek S.

Polish Journal of Surgery

2012

vol. 84

issue 9

437-444

Thyroid resection procedures are the most common endocrine surgery procedures in Poland; an estimated 25 000 procedures are performed annually. Long term patient outcomes are rarely analyzed. The aim of the study was to assess effect of complicated thyroid burgery procedur es on personal and Professional life of patients. Material and methods. Follow-up of patients with complications was conducted according to a predetermined protocol involving survey and biochemistry. Results. Unilateral and bilateral vocal cord paralysis accounted for 69% and 8% of complications, respectively. The complications resolved unilaterally in 58% of patients with bilateral vocal cord paralysis. Persistent hypoparathyroidism accounted for 26% of cases of postoperative hypoparathyroidism. Following thyroid resection procedures all patients received supplementation of thyroid hormones and were monitored by an endocrinologist until their follow-up examination. Eighty eight percent patients with vocal cord paralysis were treated at an outpatient department of laryngology and/or speech therapy. Physical therapy resulted in improvement irrespective of final nature of the complications. Vocal cord paralysis or both complications concurrently result in marked prolongation of absence from work and resulted in disability pension in 15% of professionally active patients. Low level of adaptation to diseas e was found in 19% patients in the study group, while low score on Satisfaction with Life Scale (SWLS) was found in 17% patients in the study group, irrespective of the type of complication. Conclusions. Acceptance of complications after thyroid surgical procedures is difficult for patients and worsens their life satisfaction in the long term follow-up and adversely modifies their professional and personal life. In the long term perspective, persistent hypoparathyroidism is more burdensome for patients than recurrent laryngeal nerve injury. Chronic deficit of innervations does not require chronic substitution or specialist therapy that are necessary in the persistent hypoparathyroidism.

Clinical and Metabolic Changes Following Complicated Thyroid Resection Procedures

100%

Sławeta N., Głuszek S., Heciak J.

vol. 85

issue 5

235-246

Clinical and metabolic consequences of complicated thyroid resection procedures are rarely an object of complex analysis, and teams participating in treatment may have a very limited knowledge of them. The aim of the study was to assess clinical and metabolic consequences of complicated thyroid surgical procedures. Material and methods. In the years 2002-2007, 756 patients underwent surgery due to non-neoplastic thyroid diseases. Sixty-nine (9.1%) patients experienced complications manifesting as vocal cord paralysis and/or hypoparathyroidism. Follow-up examination was conducted in a group of 42 persons, which amounted to 61% of patients who experienced complications following thyroid surgical procedures. Follow-up examination, comprising assessment of morphotic blood elements, electrolyte, lipid and parathormone blood concentrations, thyroid hormone activity, respiratory function, vocal cord mobility, bone mineralization and ultrasound examination of the pocket left after thyroid resection, was conducted after the mean period of 43 months following surgery. Results. In the analyzed group, no significant differences in plasma electrolyte content were found (sodium, potassium, magnesium, calcium and phosphorus ions). In the group of patients with chronic hypoparathyroidism, no hypophosphatemia was observed, and there were no reports of concomitant nephrolithiasis or cataract. Increased cholesterol concentration was observed in the group of patients with chronic hypoparathyroidism and without hypoparathyroidism (p = 0.07). In 35% of patients with chronic vocal cord paralysis, abnormal results of spirometry tests were obtained. In the group of patients with chronic hypoparathyroidism, densitometry examination revealed higher T-score values compared with patients with transient hypoparathyroidism and vocal cord paralysis (p = 0.07). No bone mineralization disorders manifesting as pathological fractures were noted. Conclusions. The knowledge of clinical and metabolic consequences of complicated thyroid surgical procedures, due to their complexity, may be very limited among the members of both surgical teams and teams involved in management of complications. Development of a complication following thyroid surgery may be associated with significant homeostasis disorders, especially as regards calcium-phosphate metabolism, the skeletal system and the respiratory system. Such disorders can manifest long after the disease onset, only properly intensified and long-term management allows limitation of their extent.

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2 Polish Journal of Surgery

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2 Głuszek S.

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Effect of complicated thyroid surgical procedures on personal and professional life of patients

Clinical and Metabolic Changes Following Complicated Thyroid Resection Procedures