Surgery for recurrent goitre: its complications and their risk factors.

OBJECTIVE: To find out the morbidity of reoperation for benign recurrent thyroid disease, and the risk factors associated with it. DESIGN: Retrospective study. SETTING: Specialist endocrine unit, Germany. SUBJECTS: 1031 patients operated on for recurrent goitre between 1 January 1983 and 31 December 1996. MAIN OUTCOME MEASURES: Incidence of recurrent laryngeal nerve palsy and hypocalcaemia. RESULTS: 82/1031 patients were excluded from assessment for recurrent laryngeal nerve function leaving 949 for analysis. There were no cases of bilateral permanent palsy, but 1 patient developed temporary bilateral palsy. 33 patients (3%) developed permanent unilateral palsy and 46 (5%) temporary palsy. 1307 nerves were at risk, and the rate of permanent palsy was therefore 2% of nerves at risk. This was 5 times the rate after the initial operation. Hyperthyroidism and not exposing the nerve during operation were predisposing factors. 118 patients were excluded from assessment of hypocalcaemia leaving 913 for analysis. 23 patients developed temporary hypocalcaemia (2%), but only 5 (0.5%) developed permanent hypocalcaemia. Because so few patients developed hypocalcaemia we were unable to designate risk factors. CONCLUSION: Because of the high risk of complications operations for recurrent goitre should be done only if the patient cannot be treated in any other way. The risk of recurrence should be minimised by excision of all nodules during the initial operation.