Martin Crossdale
Introduction
The day case potential of total thyroidectomy has been limited by three primary risks: post-operative haemorrhage, recurrent laryngeal nerve injury with subsequent airway embarrassment and symptomatic hypocalcaemia. In response to rising elective backlogs, transitioning to a day-case model offers
significant resource optimisation and improved patient satisfaction. We present the initial outcomes of a pilot day-case total thyroidectomy pathway within an NHS Trust.
Methods
Five consecutive patients underwent total thyroidectomy under a standardised day case protocol. The pathway prioritised: Patient selection and education: strict surgical, anaesthetic and social criteria, informed consent and education around day case management. Pre-operative Optimisation: Prophylactic loading with oral calcium and alfacalcidol. Surgical Strategy: Meticulous surgical strategy (advanced bipolar techniques,
haemostatic adjuncts, and Valsalva manoeuvres) to avoid drain insertion. Biochemical Monitoring: Immediate post-operative PTH and serum calcium measurement. Intended same day discharge: minimum post-operative stay 6 hours and until 20:00. Post-operative Safety Net: Discharge on a calcium/alfacalcidol regimen with
day one telephone follow-up and mandatory 48-hour biochemical review.
Results
The pilot achieved a 100% same-day discharge rate (n=5). No post-operative haemorrhages or hematomas occurred. One patient was readmitted following the 48-hour review for mild hypocalcaemic symptoms, requiring one night of oral optimisation. The remaining four patients remained asymptomatic with
stable biochemistry.
Conclusion
Preliminary results suggest day-case total thyroidectomy is feasible for selected patients when supported by a pathway that mitigates post-operative anaesthetic and surgical risks. While hypocalcaemia remains a concern, prophylactic supplementation and structured follow-up facilitate safe management in an ambulatory setting.
Authors
Martin Crossdale, Graham Walkden, Churunal Hari
Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom