Postoperative Adhesion after Thyroid Surgery

Young Min Kim; Su-jin Kim; Jin Wook Yi; Chan-Yong Seong; Jong-Kyu Kim; Hyeong Won Yu; Young Jun Chai; June Young Choi; Kyu Eun Lee

doi:10.16956/kjes.2016.16.4.94

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Kim, Kim, Yi, Seong, Kim, Yu, Chai, Choi, and Lee: Postoperative Adhesion after Thyroid Surgery

Original Article

Korean J Endocrine Surg 2016;16(4):94-99.

Published online: 10 December 2016

DOI: https://doi.org/10.16956/kjes.2016.16.4.94

Postoperative Adhesion after Thyroid Surgery

Young Min Kim, Su-jin Kim, Jin Wook Yi, Chan-Yong Seong, Jong-Kyu Kim, Hyeong Won Yu¹, Young Jun Chai², June Young Choi¹, Kyu Eun Lee

Department of Surgery, Seoul National University Hospital and College of Medicine, Cancer Research Institute, Seoul National University College of Medicine, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea

¹Department of Surgery, Bundang Seoul National University Hospital, Seongnam, Korea

²Department of Surgery, Boramae Medical Center, Seoul, Korea

Correspondence: Su-jin Kim Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: ＋82-2-2072-7208 Fax: ＋82-2-766-3975 e-mail: su.jin.kim.md@gmail.com

Received 5 September 2016 Accepted 26 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Postoperative adhesion after thyroidectomy results in neck discomfort and swallowing difficulty. However, risk factors for adhesive symptom after thyroidectomy have not been well studied. This study evaluated symptoms related to postoperative adhesion after thyroidectomy.

Methods

The Glasgow-Edinburgh Throat Scale (GETS) questionnaire was used to evaluate postoperative adhesion. Patients who completed the GETS questionnaire either pre- or post- operatively were enrolled. Patient clinical and pathological details including age, gender, body weight, body mass index (BMI), tumor size, thyroid volume, extent of thyroidectomy, postoperative months, and neck thickness on ultrasonography and computed tomography (CT) were abstracted.

Results

Twenty-eight preoperative (22 females, six males) and 101 postoperative (83 females, 18 males) patients were enrolled. The mean age of the pre-operative enrollees was 52.1±11.7, and of post-operative enrollees 51.8±12.4 years. Patients who were within one month post-surgery had higher GETS scores than preoperative patients (27.4±20.1 vs. 6.5±11.1, P＜0.001). Two months after surgery, GETS scores of postoperative patients did not differ significantly from the scores of the preoperative patients. There were no significant associations between clinical and pathologic features (age, tumor size, BMI, neck thickness on ultrasonography and CT) and GETS scores.

Conclusion

Postoperative adhesive symptoms were most severe at one month after surgery, while questionnaire scores two months after surgery were comparable with preoperative patients. Further studies will be required for better understanding of the natural course of postoperative adhesion after thyroidectomy.

Keywords: Thyroidectomy, Postoperative adhesion, Neck discomfort

References

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Fig. 1.

Distribution of the patients included in the study. MRND = Modified radical neck dissection; GERD = Gastroesophageal reflux disease.

Fig. 2.

The change of Glasgow-Edinburgh Throat Scale (GETS) scores according to postoperative period.

Table 1.

The Glasgow-Edinburgh Throat Scale (GETS) questionnaire

								Unbearable
1	Feeling of something stuck in the throat	1	2	3	4	5	6	7
2	Pain in the throat	1	2	3	4	5	6	7
3	Discomfort/irritation in the throat	1	2	3	4	5	6	7
4	Difficulty in swallowing food	1	2	3	4	5	6	7
5	Throat closing off	1	2	3	4	5	6	7
6	Swelling in the throat	1	2	3	4	5	6	7
7	Catarrh down throat	1	2	3	4	5	6	7
8	Can’t empty throat when swallowing	1	2	3	4	5	6	7
9	Want to swallow all the time	1	2	3	4	5	6	7
10	Food sticking when swallowing	1	2	3	4	5	6	7
11	How much time do you spend thinking abou your throat?	1	2	3	4	5	6	7
12	At present, how annoying do you find your throat sensation?	1	2	3	4	5	6	7

Table 2.

Demographics and clinicopathologic characteristics of patients who underwent thyroidectomy

Characteristics	N=101
Age, years (range)	51.8 (19∼82)
Sex (male:female)	18:83
Body mass index, kg/m²	24.0±3.2
Skin thickness at CT (skin to platysma muscle), mm	4.8±1.9
Skin thickness at CT (skin to isthmus), mm	8.6±3.9
Skin thickness at US (skin to platysma muscle), mm	1.4±0.4
Skin thickness at US (skin to isthmus), mm	4.4±1.5
Extent of thyroidectomy
Total thyroidectomy (%)	77 (76.2%)
Subtotal thyroidectomy (%)	4 (4.0%)
Unilateral lobectomy (%)	20 (19.8%)
Disease
Papillary thyroid cancer	89
Minimally invasive follicular carcinoma	2
Widely invasive follicular carcinoma	1
Benign nodule	9
Tumor size, cm	1.1±1.2
Median follow-up period, months (range)	19.9 (1∼187)

US = Ultrasonography.

Table 3.

Glasgow-Edinburgh Throat Scale (GETS) score according to postoperative period

Evaluation time	n	GETS	P
Preop	28	6.5	−
＜1 month	11	27.36	0.000^*
1∼6 months	37	9.78	0.101^*
7∼12 months	14	9.36	0.249^*
13∼24 months	12	8.17	0.130^*
25∼36 months	15	8.47	0.917^*
37 months∼	12	10.75	0.493^*

^* Mann-Whitney test with preoperative GETS score.

Table 4.

Association of clinicopathological features with Glasgow-Edinburgh Throat Scale score according to postoperative follow-up period

GETS score
	Preop (n=28)			＜1 month (n=11)			1∼6 months (n=37)			7∼12 months (n=14)			13∼24 months (n=12)			25∼36 months (n=15)			37 months∼ (n=12)
	N	Mean	P value	N	Mean	P value	N	Mean	P value	N	Mean	P value	N	Mean	P value	N	Mean	P value	N	Mean	P value
Age
＜45	8	6.6	0.862	4	31.0	0.648	11	13.8	0.832	4	2.5	0.142	3	9.7	0.727	5	4.6	0.953	2	2.5	0.758
≥45	20	6.5		7	25.3		26	11.5		10	12.1		9	7.7		10	10.4		10	12.4
Tumor size
＜1 cm				8	27.6	0.776	21	13.2	0.554	7	8.1	0.535	11	8.9	0.167	12	10.3	0.308	5	2.2	0.151
≥1 cm				3	26.7		16	10.9		7	10.6		1	0.0		1	0.0		5	19.8
BMI
＜25				8	24.8	0.63	23	14.3	0.526	11	9.5	0.769	7	6.6	0.268	10	12.2	0.142	6	7.7	0.857
≥25				3	34.3		14	8.7		3	9.0		5	10.4		4	1.3		2	2.0
CT_P
＜4.8 mm				6	28.2	0.931	18	17.4	0.098	9	6.4	0.24	7	8.9	0.639	10	12.0	0.165	8	13.1	0.683
≥4.8 mm				5	26.4		19	7.3		5	14.6		5	7.2		5	1.4		4	6.0
CT_I
＜8.4 mm				4	27.3	0.927	17	17.2	0.117	9	5.6	0.083	7	7.4	0.755	11	10.9	0.412	10	12.5	0.485
≥8.4 mm				7	27.4		20	7.9		5	16.2		5	9.2		4	1.8		2	2.0
US_P
＜1.4 mm				8	31.6	0.376	14	6.5	0.657	7	7.6	0.620	4	5.3	0.368	8	4.9	0.463	9	13.6	0.600
≥1.4 mm				3	16.0		23	15.7		7	11.1		8	9.6		7	12.6		3	2.3
US_I
＜4.2 mm				7	24.6	0.527	14	13.8	0.722	9	10.8	0.699	8	9.4	0.461	8	14.3	0.121	10	8.6	0.364
≥4.2 mm				4	32.3		23	11.2		5	6.8		4	5.8		7	1.9		2	21.5

CT_P = Skin thickness at CT (skin to platysma muscle); CT_I = Skin thickness at CT (skin to isthmus); US_P = Skin thickness at ultrasonography (skin to platysma muscle); US_I = Skin thickness at ultrasonography (skin to isthmus).

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