What are the complications after thyroid surgery? How to deal with them?

Hyperthyroidism, also known as hyperthyroidism, if hyperthyroidism is not treated correctly, what complications will occur? How should we deal with these symptoms?

1. Difficulty breathing and suffocation

Dyspnea and suffocation are critical complications after surgery, which usually occur within 48 hours after surgery. Clinical manifestations include progressive dyspnea, irritability, and even suffocation; there may be neck swelling and bleeding from the incision.

2. Recurrent laryngeal nerve damage

Recurrent laryngeal nerve injury is mainly caused by direct injury during surgery, such as cutting, suturing, contusion or excessive pulling. A small number of cases are caused by compression of blood swelling or pulling of scar tissue. The former will show symptoms immediately during surgery, while the latter will show symptoms several days after surgery. Cutting and suturing cause permanent injuries; contusion, pulling or compression of blood swelling cause temporary injuries, which can generally recover gradually within 3 to 6 months after treatment. Hoarseness caused by unilateral recurrent laryngeal nerve damage can be improved by excessive adduction of the healthy vocal cord toward the affected side; bilateral recurrent laryngeal nerve damage will lead to bilateral vocal cord paralysis, causing aphonia or severe dyspnea, requiring tracheotomy.

3. Superior laryngeal nerve damage

It is usually caused by ligating or cutting the superior thyroid artery and vein, which is far from the upper pole of the thyroid gland and is not carefully separated, and the surrounding tissue is ligated together. Injury to the external branch will paralyze the cricothyroid muscle, causing the vocal cord to relax and the pitch to drop. Injury to the internal branch will cause loss of sensation of the laryngeal mucosa, making it easy to swallow incorrectly and cough when drinking water. Generally, it can recover on its own after treatment.

When eating, especially when drinking, patients should be observed for choking, inappetence, etc. Therefore, patients should be observed more closely during eating. Patients should be encouraged to sit up to eat or eat semi-liquid solid food, such as millet porridge, dumpling soup, chicken soup, fish soup, noodles, etc. The eating speed should not be too fast to avoid choking.

4. Hand and foot convulsions

Cause: The parathyroid gland is missected or the blood supply is insufficient. The blood calcium level drops below 2.0mmol/L. The mildest symptoms are numbness of the face, lips, hands and feet, and the worst are convulsions of the limbs. Prevention should emphasize the protection of the parathyroid gland safety area during surgery to avoid missecting the parathyroid gland or loss of blood supply.

Treatment: For mild symptoms, oral calcium can be taken. For severe cases, 10% calcium gluconate 10-20ml can be injected intravenously during an attack; oral dihydrotachysterol has a better long-term effect.

Diet should be properly controlled, and foods with high phosphorus content should be limited to avoid affecting calcium absorption. Such as seaweed, fresh milk, pork, fish and shrimp, etc. Patients should be given high-calcium and low-phosphorus foods, such as green leafy vegetables, egg yolks, animal offal, milk, etc., to supplement calcium and prevent tetany caused by low calcium. Patients are advised to increase calcium-rich foods such as shrimp skin, green vegetables, bone soup, sesame paste, etc., avoid cereals, wheat bran, nuts and other phosphorus-rich foods, and promote cod liver oil, liver, egg yolk and butter with high vitamin D content.

5. Thyroid crisis

Causes and inducements: It may be related to inadequate preoperative preparation and uncontrolled hyperthyroidism symptoms. Symptoms include postoperative high fever (>39°C), tachycardia (>120 beats/min), vomiting and mental symptoms, etc., which often occur within 36 hours after surgery and are serious.

handle:

① Oral administration of iodine or intravenous infusion of 5-10 ml of sodium iodide (added to 500 ml of glucose solution);

②Application of hormones;

③ Propranolol taken orally or intravenously;

④Others: Application of sedatives, antihypertensive drugs, cardiotonic drugs, cooling, oxygen inhalation, etc.

Before surgery, instruct patients to increase nutrition and choose a high-calorie, high-protein, high-vitamin diet to increase surgical tolerance. Make adequate preoperative preparations to prevent postoperative complications. At the same time, strong tea, coffee and other stimulant drinks are prohibited. If necessary, a gastric tube should be placed after surgery. Vitamin supplements should be sufficient, especially B vitamins and vitamin C.