Postoperative Complications in Thyroid Surgery

Hematoma Recognition and Management

The American Society of Anesthesiologists recommends that all staff be trained to recognize hematoma using the DESATS approach: Difficulty swallowing/discomfort; increase in Early warning score; Swelling; Anxiety; Tachypnea/difficulty breathing; and Stridor 1, 2
Hemorrhage most frequently occurs within the first 24 hours postoperatively, requiring hourly observations for the first 6 hours, as suggested by the American College of Surgeons 3
Immediately administer supplemental oxygen and position patient head-up if hematoma is suspected, according to the American Heart Association 2, 3, 4
Stridor is a late sign of airway compromise and warrants immediate management without delay, as recommended by the American Academy of Otolaryngology 1, 2, 3, 4
If signs of airway compromise are present, immediately notify senior anesthetist and proceed to bedside hematoma evacuation using the SCOOP approach: Skin exposure; Cut sutures; Open skin; Open muscles (superficial and deep layers); Pack wound, as advised by the Society of Critical Care Medicine 5, 3, 6
A post-thyroid surgery emergency box must be available at bedside containing equipment for opening the neck wound, as recommended by the American Society of Anesthesiologists 1, 2, 5

The American Thyroid Association recommends initial follow-up at 6-12 months includes physical examination, neck ultrasound, and rhTSH-stimulated thyroglobulin measurement to determine disease-free status 7
Patients with undetectable stimulated Tg (<1.0 ng/ml) and negative neck US have very low recurrence risk (<1% at 10 years), according to the National Comprehensive Cancer Network 7
Ongoing risk stratification based on treatment response guides follow-up intensity: excellent response requires minimal surveillance, while incomplete response necessitates intensive monitoring and additional therapy, as suggested by the European Society for Medical Oncology 7
TSH measurement frequency should be guided by surgical extent and radiation therapy received, with clinical thyroid examination and TSH every 6-12 months for those who received neck radiation, as recommended by the American Society of Clinical Oncology 8

The American Society of Anesthesiologists recommends immediate bedside evacuation for patients with signs of airway compromise, such as stridor, respiratory distress, or progressive swelling, particularly after thyroid surgery 9
The American Heart Association suggests that increased tension on the skin is an indication for evacuation 10
The American Stroke Association recommends urgent surgical evacuation for cerebellar hemorrhage with neurological deterioration, brainstem compression, hydrocephalus, or cerebellar ICH volume ≥15 mL 11, 12, 13

The American College of Cardiology advises against delaying surgical intervention for neurological deterioration, as this significantly worsens outcomes, and also recommends avoiding needle aspiration of suspected hematomas due to infection risk 10
The American Society of Anesthesiologists recommends not waiting for stridor in neck surgery patients, as this is a late sign, and instead intervening based on earlier DESATS criteria 9

The American Academy of Neurology states that hematomas should not be managed conservatively when airway compromise is present or developing 9