Patients with Graves Disease at Increased Risk for Hematoma Following Thyroid Surgery

by Amy E. Hamaker •

Is there a difference in hematoma rates following thyroidectomy for patients with Graves disease, toxic nodular goiter (TNG), and malignancy?

Bottom line
Graves disease is the only indication in which patients undergoing thyroidectomy are at increased risk of postoperative hematoma formation.

Background: Concern for postoperative hematoma is a limitation to thyroidectomy routinely being performed on an outpatient basis. Patient subgroups who may be at increased risk for hematoma formation include inflammatory thyroid disease, such as Graves disease and toxic nodular goiter (TNG), and malignancy. There is no consensus, however, regarding a truly increased hematoma rate in any or all of these groups.

Study design: Systematic review and meta-analysis of 11 studies from 1946–2015, with a total of 48,381 patients (3,185 Graves disease; 4,191 cancer; 6,836 toxic thyroid conditions; 34,169 other thyroid conditions).

Setting: Ovid MEDLINE, EMBASE, and PubMed databases.

Synopsis: The overall postoperative hematoma formation rate was 1.66% in the Graves group and 1.44% in the Other group. Pooled operating rooms, using a random effects model, revealed a statistically significant difference in hematoma rates between Graves thyroidectomy and thyroidectomy for Other.

The overall postoperative hematoma formation rate was 1.76% in the TNG group and 1.52% in the Other group. The overall post-operative hematoma formation rate was 1.41% in the cancer group and 1.52% in the Other group. The overall post-operative hematoma formation rate was 1.56% in the Graves group and 1.76% in the TNG group. The overall postoperative hematoma formation rate was 1.68% in the Graves group and 1.41% in the cancer group. Pooled operating rooms did not reveal a statistically significant difference in hematoma rates, but there was a trend toward increased hematoma rates in the Graves group. Limitations of the study included a lack of definition in studies of the time taken postoperatively for hematoma formation, a lack of standardization in drain use, and the fact that many of the included studies grouped hematoma rates following both total and subtotal/hemithyroidectomies.

Citation: Quimby AE, Wells ST, Hearn M, Javidnia H, Johnson-Obaseki S. Is there a group of patients at greater risk for hematoma following thyroidectomy? A systematic review and meta-analysis; Laryngoscope. 2017;127:1483–1490.