Thyroid surgery in the elderly.

Abstract

Thyroid disease is common in the elderly but appropriate surgical procedures are frequently avoided in the belief that the patient's age precludes a successful outcome. This avoidance may result in surgery having to be performed at a later stage as an emergency when conditions are not necessarily ideal for treatment of airway obstruction by goitrous tissue. Between 1970 and 1985, 575 patients aged over sixty years underwent thyroidectomy in The University of Sydney Department of Surgery at Royal North Shore Hospital. The most commonly performed procedure was total thyroid lobectomy (185); there were however a significant number of total thyroidectomies (86), 41% for benign and 59% for malignant thyroid pathology. The complication rate was considered to be acceptably low in this group. Complications of thyroid surgery itself occurred in 1.2%, recurrent laryngeal nerve palsy 1%, and hypoparathyroidism 0.2%. Other complications (4.8%) were those to be expected in an elderly patient population with multiple pathology and comprised myocardial infarction, cardiac arrhythmias and respiratory problems. There were 2 deaths in this group (0.4%), one occurred when the endotracheal tube perforated the trachea of a patient whose thyroid malignancy proved to be invading the trachea. The accumulated data in this study showed that age, regardless of pathological classification, was the major single prognostic factor for survival in thyroid malignancy. Aged patients can undergo thyroid surgery with no significantly added risk provided specific associated problems are addressed before operation.