Complications From Thyroid Cancer Surgery More Common Than Once Thought

Key Points

  • Researchers identified three groups for which both general and thyroid surgery–specific complications were more common: patients older than 65, patients with more advanced thyroid cancer, and patients with other coexisting medical conditions.
  • 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.
  • Researchers said conversations about limiting surgery for those with low-risk disease may be appropriate.

As thyroid cancer rates rise, more patients are having surgery to remove all or part of their thyroid. A new study by Papaleontiou et al in The Journal of Clinical Endocrinology & Metabolism suggests complications from these procedures are more common than previously believed.

Overall, 6.5% of patients with thyroid cancer had general postoperative complications in the month after surgery, and 12% had complications specific to thyroid surgery within the year after their operation. However, the risks were significantly higher for certain groups, suggesting the opportunity for targeted interventions and education to improve outcomes.

“That 12% of patients overall had thyroid surgery–specific complications is concerning. Most of our surgeons quote a 1% to 3% rate. This is quadruple what we had thought,” said lead study author Maria Papaleontiou, MD, Assistant Professor of Metabolism, Endocrinology, and Diabetes at Michigan Medicine.

The majority of previous studies on thyroid surgery complications have been from single institutions, often high-volume centers, which are known to have better outcomes.

The new study looked at 22,867 people who had surgery for thyroid cancer between 1998–2011. Data was collected from the Surveillance, Epidemiology and End Results-Medicare linked database.

Major Findings

Researchers looked at general postoperative complications—fever, infection, blood clots, or swelling—that occurred within the first 30 days after surgery. They also looked at complications specific to thyroid surgery—such as hypoparathyroidism, hypocalcemia, and vocal cord or fold paralysis—which can have a lifelong impact on patients.

Researchers identified three groups for which both general and thyroid surgery–specific complications were more common:

  • Patients older than 65 years
  • Patients with more advanced thyroid cancer
  • Patients with other coexisting medical conditions.

Older patients were about 3 times more likely to have complications than those younger than 65. About 10% of older patients developed general postoperative complications, and 19% had thyroid surgery-related complications. For patients younger than 65, 3% had general complications and 6% had thyroid surgery-related complications.

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, a number the researchers called “alarming.”

“Thyroidectomy is considered a fairly safe operation in general, but some populations are more vulnerable and need extra attention in pre- and post-operative care,” Dr. Papaleontiou said.

The researchers suggest better educating patients and providers so that those at risk of complications seek out high-volume surgeons that tend to have better outcomes. Other studies have shown that low-volume surgeons perform a disproportionate number of thyroid surgeries in the United States.

In addition, the researchers say it's crucial to educate endocrinologists—who typically treat hypoparathyroidism or hypocalcemia—on the likelihood of these risks on patients who have had thyroid cancer surgery.

Commentary

“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,” said senior study author Megan R. Haymart, MD, Assistant Professor of Metabolism, Endocrinology, and Diabetes at Michigan Medicine.

In addition, Dr. Haymart said conversations about limiting surgery for those with low-risk disease may be appropriate.

“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,” Dr. Haymart said. “Are there options to do less extensive surgery for these patients? If the cancer control benefits are similar but the risks of long-term complications would be less, we need to provide patients with this option.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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