Risk of Complications After Thyroidectomy Not Increased in Older Patients, Study Reports

Advanced age does not increase the risk of postoperative complications in patients older than 70 who undergo a total thyroidectomy — a surgical procedure that removes the entire thyroid gland — a prospective study shows.

The study, “Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study,” was published in The American Journal of Surgery.

The thyroid is a gland located at the front of the neck responsible for the production and secretion of hormones essential for regulating growth, heart rate, body temperature, and metabolism.

The incidence of thyroid dysregulation and formation of internal nodules increases with age, affecting up to 90% of women older than 60 and 80% of men older than 80.

Previous studies have already shown that total thyroidectomy is feasible in elderly patients who have thyroid cancer, a noncancerous thyroid enlargement (goiter), or an overactive thyroid (hyperthyroidism).

Despite being recommended as a course of treatment for these medical conditions, the surgery is linked to several postoperative complications, including bleeding, lack of calcium (hypocalcemia), recurrent laryngeal nerve palsy (RLNP; paralysis of the larynx), and lack of thyroid activity (hypoparathyroidism) in patients of all ages.

However, some studies suggested that advanced age could further increase the risk of surgery complications, because older patients are more likely to be affected by other comorbidities, or coexisting conditions.

In this study, researchers investigated whether older patients who underwent a total thyroidectomy would be more likely to develop postoperative complications, including RLNP and hypoparathyroidism.

Between March 2012 and June 2014, the prospective, multicenter, single-blind Phase 3 FOThyr trial (NCT01551914) enrolled a total of 1,329 patients — 1,062 women and 262 men — who were divided into two groups: those younger than 70 (92.4%); and those 70 and older (7.6%).

The primary goal of the study was to assess the percentage of patients showing postoperative hypocalcemia (low calcium levels characteristic of hypoparathyroidism) two days after surgery. Secondary goals included analyzing the incidence of RLNP at different points after the surgery, hypocalcemia six months after surgery, and postoperative pain.

Two days after surgery, 20.02% of patients developed hypocalcemia. Although there was no statistically significant difference between the two groups of patients, the rates of hypocalcemia tended to be lower among older patients (14.85%) compared with younger patients (20.44%).

Six months after surgery, the percentage of patients with hypocalcemia dropped significantly (1.98%), and no differences were observed between the two groups.

For RLNP incidence, no differences were found between the two groups two days and six months post-surgery.

Data also revealed that patients older than 70 were in less pain than those who were younger.

These findings confirmed that total thyroidectomy is not only feasible in older patients, but it also seems to be a relatively safe procedure whose risks are not aggravated by advanced age.

“Our study is the largest prospective study evaluating surgical specific complications of total thyroidectomy. This work is in line with literature; there are no more complications related to surgery in elderly people,” the researchers concluded.