Evaluation of Preoperative Factors as Predictors of Difficult Thyroidectomy: A Prospective Study

Introduction Thyroidectomy is one of the most common surgical procedures performed worldwide. The complications from thyroidectomy are less, yet they can be life-threatening. The purpose of our study was to evaluate the role of preoperative clinical and biochemical factors in predicting difficult thyroidectomy (DT) and its influence on complications. Methodology Fifty-two patients were enrolled in the study, all of whom underwent total or hemithyroidectomy. Preoperative clinical parameters, including large goiter, presence of compressive neck symptoms, retrosternal extension, duration of goiter, and presence of toxic symptoms, were noted. Biochemical tests, including thyroid function tests and thyroglobulin levels, were performed preoperatively. Intraoperative difficulty in thyroidectomy was assessed using the thyroidectomy difficulty scale (TDS). The correlation between complications and TDS was evaluated. Results Preoperative clinical features like the presence of compressive neck symptoms (p=0.003), the presence of a large goiter (p=0.0004), the presence of retrosternal extension (p=0.014), and the long duration of goiter (p=0.0003) were significantly associated with DT. Biochemical features like raised serum thyroglobulin levels were significantly associated with DT (p=0.0004). There was a linear relationship between operating times and TDS scores with higher TDS scores associated with longer operating times. Postoperatively, median serum parathyroid hormone (PTH) levels were found to be significantly lower in the DT group at 48 hours postoperatively (p=0.019). Vocal cord palsy was found to be statistically significant (P-value: 0.0013) in the DT group. Discussion and conclusions The TDS and longer operating times were used to categorize DTs. Preoperative clinical features can help the surgeon predict whether thyroid surgery will be classified as a DT and alert them to the potential for postoperative complications in this patient group.