Complication Profile of Reoperative Thyroidectomy Versus First-Time Thyroidectomy: A Systematic Review and Meta-analysis
In brief
Reoperative thyroidectomy raises permanent vocal-cord injury risk nearly fourfold
In a meta-analysis of 23 studies involving over 42,000 patients, repeat thyroid surgery was linked to about twice the odds of transient hypocalcemia and a 1.8-fold rise in permanent hypocalcemia, as well as a 1.8-fold increase in postoperative hematoma. The striking four-fold rise in permanent recurrent laryngeal nerve injury underscores the need for careful patient selection and counseling.
- Journal
- The Journal of surgical research (Q1)
- Published
- 17 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Ahmed Ghani, Erasmus van Zoest, Al-Shifaa S Al Rashdi, Lamees M Al Darwashi, Aris Rafati, May Y Hajeir, et al.
- PMID
- 42753362
- DOI
- 10.1016/j.jss.2026.08.045
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 20 September 2026): Thyroidectomy complications, directly relevant to ENT surgery
- Picked for Breast and Endocrine Surgery (paper of the day, 18 September 2026): Complication profile of reoperative thyroidectomy versus first‑time thyroidectomy
Abstract
INTRODUCTION: Reoperative thyroidectomy, defined as surgery for recurrent thyroid disease following prior thyroid resection, is widely perceived to carry a greater likelihood of complications than first-time thyroidectomy due to anatomic distortion and scar formation. Despite recognition of these challenges, the existing evidence is heterogeneous and lacks comprehensive synthesis. Thus, this meta-analysis aims to evaluate the comparative complication rates between reoperative and first-time thyroidectomy. METHODS: PubMed, Ovid Embase, Cochrane Library, CINAHL, Scopus, and Web of Science were searched from their respective inception dates to October 2025. The review was registered prospectively on the PROSPERO database (CRD420251158243). RESULTS: Twenty-three studies comprising 42,314 patients were included, of whom 4154 (9.8%) underwent reoperative thyroidectomy. Reoperative thyroidectomy was associated with greater odds of transient hypocalcemia (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.06-2.20; I2 = 84%), permanent hypocalcemia (OR = 1.88; 95% CI: 1.33-2.67; I2 = 24%), transient recurrent laryngeal nerve (RLN) injury (OR = 2.57; 95% CI: 1.73-3.83; I2 = 72%), permanent RLN injury (OR = 3.94; 95% CI: 2.60-5.97; I2 = 47%), and hematoma (OR = 1.76; 95% CI: 1.12-2.78; I2 = 7%) when compared with first-time thyroidectomy. CONCLUSIONS: Reoperative thyroidectomy appears to carry a higher likelihood of complications than first-time thyroidectomy with an almost 4-fold increase in odds of permanent RLN injury. These findings emphasize the importance of appropriate patient counseling, careful patient selection, and clear clinical indications when considering reoperative thyroidectomy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.