Thyroid Cancer Surgery Complications Higher Than Predicted

Thyroid cancer surgery complication rates are greater than predicted, and patients who are older, with more comorbidities, and with advanced disease are at greatest risk, according to a new study.

Researchers at University of Michigan conducted a study of 27,912 patients that underwent surgery for differentiated or medullary thyroid cancer between 1998 and 2011. Using data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database, the researchers evaluated general complications that occurred within 30 days of surgery, and thyroid surgery specific complications within one year of surgery.

The results showed that 6.5% of the patients developed general post-operative complications, which included fever, infection, hematoma, cardiopulmonary, and thromboembolic events; 12.3% developed thyroid surgery specific complications, including hypoparathyroidism, hypocalcemia, and vocal cord and fold paralysis. Complication rates were significantly higher in patients 65 years of age and older, patients with more advanced thyroid cancer, and patients with other co-existing medical conditions. The study was published on April 28, 2017, in the Journal of Clinical Endocrinology and Metabolism.

“Even in low-risk patients, the risk of vocal cord paralysis is still 2% and the risk of hypoparathyroidism is 8%. This is higher than we'd like to see,” said senior author Megan Haymart, MD. “When we work with patients to treat thyroid cancer, we're always balancing benefits and risks. This study shows there are more complications from surgery for thyroid cancer than expected. It suggests an opportunity to educate both patients and providers to decrease complications and improve outcomes.”

“That 12% of patients overall had thyroid surgery specific complications is concerning; most of our surgeons quote a one to three percent rate. This is quadruple what we had thought,” added lead author Maria Papaleontiou, MD. “Thyroidectomy is considered a fairly safe operation in general, but some populations are more vulnerable. Advanced disease was associated with the highest number of complications; 23% of patients whose cancer had spread throughout the body had thyroid surgery specific complications.”