Thyroid surgery in the geriatric patient.

BACKGROUND: Although age itself is no contraindication for major surgical procedures, few patients 75 years and older undergo thyroid surgery. HYPOTHESIS: Thyroid surgery in the geriatric patient can be performed with low morbidity and mortality.
DESIGN: Retrospective analysis of prospectively documented data.
SETTING: University hospital referral center. PATIENTS: We included 738 patients undergoing thyroid surgery within 5 years, of whom 55 (7.5%) were 75 years or older (group 1) (mean +/- SD age, 79.9 +/- 4.1 years). MAIN OUTCOME MEASURES: Indication for surgery, surgical strategy, morbidity, and mortality were analyzed and compared with those in younger patients (<75 years; group 2).
RESULTS: Malignancy was suspected or verified in 29 patients (52.7%) in group 1; 21 (38.2%) had mechanical symptoms due to large bilateral nodular goiters; and 5 (9.1%) presented with benign nodular goiter. The main indication in group 2 (n = 683) was benign nodular goiter in 455 (66.6%); 142 patients (20.8%) presented with suspected malignancy and 21 (3.1%) with mechanical symptoms (P<.001). Most patients underwent total thyroidectomy, hemithyroidectomy, or near-total thyroidectomy (n = 50 [90.9%; group 1] vs n = 597 [87.4%; group 2]; P =.53). Frequency of malignancy was higher in group 1 ([n = 20 [36.4%] vs n = 179 [26.2%]; P =.17). Morbidity of thyroid surgery was comparable in both groups. One (2.3%) of 44 patients in group 1 had permanent hypoparathyroidism, compared with 10 (2.0%) of 502 in group 2 (P =.61); permanent recurrent laryngeal nerve paralysis occurred in 1 (1.05%) of 95 nerves at risk in group 1 compared with 3 (0.26%) of 1172 nerves at risk in group 2 (P =.22). There was no perioperative mortality in either group.
CONCLUSIONS: Thyroid surgery in patients 75 years or older can be performed with low morbidity. The guarantees for success include an individual risk-and-benefit analysis and careful preoperative preparation.