Morbidity after thyroid surgery: patient perspective

Abstract

Objectives/hypothesis: To evaluate patient perception of morbidity after thyroid surgery.

Study design: Survey of consecutive patients (case series).

Methods: A standardized questionnaire was mailed to 312 patients who underwent thyroid surgery during a 3-year period (January 2008 to December 2010).

Results: Replies were received from 202 (64%) patients (56 male, 166 female; age, 55 ± 16 years) at 6 to 39 months (median, 23 months) after lobectomy (n = 119) or total thyroidectomy (n = 76) for benign (n = 160) or malignant (n = 42) conditions. Subjective voice assessment using a visual analogue scale was normal in 111 patients, deteriorated in 80 patients, and improved in 21 patients. Voice handicap index scores were normal in 126 (62%) patients and increased in 76 (38%) patients to a median of 17 (range, 11-29). Voice-related quality of life was excellent in 107 (53%) patients, fair to good in 66 patients, and poor to fair in 29 patients. Subjective assessment of swallowing was reported as normal in 84 patients, moderately affected in 56 patients (score, 11-15) and severely affected in 62 patients (score, 16-40; median, 23). Calcium supplements prescribed routinely after bilateral surgery were interrupted within 2 to 4 weeks in 56 patients and within 3 to 6 months in 18 patients. None of the respondents had persistent hypoparathyroidism. Appearance of the scar assessed using the Manchester score ranged from 5 to 16 (median, 7). Asked whether they would consider robotic thyroid surgery to avoid a cervical scar, only 38 patients said they were definitely interested.

Conclusions: A large proportion of patients report persistent moderate voice and swallowing problems after thyroid surgery. These findings are similar to a recent international multicenter survey of more than 2,000 patients with thyroid cancer. Hypocalcemia and cosmetic outcome raised no significant concerns.

Keywords: Thyroid surgery; hypocalcemia; scar; voice changes.