Thyroidectomy is a common surgical procedure performed to remove all or part of the thyroid gland, a butterfly-shaped organ located at the base of the neck. While generally considered a safe operation, like any surgical intervention, it carries potential risks. One such complication, though uncommon, is the development of a hematoma.
Understanding Hematomas After Thyroidectomy
A hematoma is a collection of blood that forms outside of blood vessels, often resembling a large bruise. After a thyroidectomy, a hematoma can develop in the neck area due to the disruption of blood vessels during the surgical procedure. This bleeding can occur from small vessels that were not fully sealed or from larger vessels if a suture or clip dislodges. The incidence of post-thyroidectomy hematoma varies, but it is generally uncommon. Although uncommon, a neck hematoma is a serious complication of thyroid surgery due to its potential impact on the airway. Most cases occur within the first 24 hours following surgery, often within the initial six hours, though they can develop later.
Identifying the Symptoms
Recognizing the signs of a hematoma after thyroidectomy is important for timely intervention. A noticeable symptom is swelling or an expanding mass in the neck, particularly beneath the incision site. This swelling may be accompanied by bruising over the surgical area. Patients might also experience increased pain in the neck that was not present immediately after surgery or that worsens over time.
Other symptoms can include a choking sensation or a feeling of pressure in the neck as the hematoma expands and presses on surrounding structures. Difficulty swallowing or changes in voice, such as hoarseness, may also occur. In some instances, there might be noticeable bleeding or drainage from the surgical wound.
When to Seek Urgent Care
A developing hematoma after thyroidectomy can quickly become an emergency due to the confined space of the neck and the potential for airway compression. If any of the previously mentioned symptoms are observed, particularly if they are worsening, immediate medical attention is necessary. Airway obstruction can progress quickly, leading to acute respiratory distress or even suffocation.
Contact the surgical team or go to the nearest emergency room if there is significant or rapidly expanding neck swelling, difficulty breathing, stridor, or changes in consciousness. In cases of severe airway compromise, immediate opening of the wound at the bedside may be necessary to relieve pressure and restore breathing, even before reaching the operating room.
Medical Management of Hematomas
Medical professionals use several approaches to manage hematomas after thyroidectomy, depending on the size and impact of the blood collection. A physical examination is conducted to assess the extent and firmness of the swelling, along with monitoring vital signs to determine the patient’s overall condition. Imaging techniques, such as cervical ultrasonography or CT scans, may be used to confirm the diagnosis and visualize the size and location of the hematoma.
For small hematomas not causing significant symptoms or airway compromise, a conservative approach involving observation may be considered, as they can resolve on their own within three to six weeks. Larger or symptomatic hematomas, especially those causing airway compression, require immediate surgical intervention. This involves returning to the operating room to open the incision, evacuate the blood clot, and identify and control the source of bleeding through ligation or cauterization of vessels. In situations of acute airway distress, an emergency bedside evacuation of the hematoma might be performed to relieve immediate pressure on the trachea.
Reducing the Risk
Medical teams implement various measures to minimize the risk of hematoma formation following thyroidectomy. Pre-operative assessment plays an important role, including careful management of underlying conditions such as hypertension and hyperthyroidism. Patients taking anticoagulant medications or antiplatelet agents may have these medications adjusted or temporarily stopped before surgery to reduce bleeding risk.
During the surgical procedure, meticulous hemostasis is performed using various techniques. Performing a Valsalva maneuver before closing the incision can help identify any occult venous bleeding points. Post-operative monitoring in the recovery room is also performed to detect any early signs of swelling or respiratory distress.