D. Spencer1, A. Grigorian1, S. Schubl1, K. Awad1, D. Elfenbein1, T. Dogar1, J. Nahmias1 1University Of California – Irvine,Division Of Trauma, Burns & Surgical Critical Care,Orange, CA, USA
Introduction: Traumatic injury to the thyroid is rare with no large studies previously published. Although the thyroid is not considered an immediately vital structure, it is in close proximity to several critical structures such as the carotid arteries, trachea, esophagus, and cervical spine. We sought to describe the national incidence of traumatic thyroid injury as well as mortality rate, rate of operative intervention, and frequencies of concomitant injury to surrounding structures. We hypothesized isolated thyroid injury would have a lower mortality compared to thyroid with concomitant carotid artery, trachea, esophagus or cervical spine injury.
Methods: National Trauma Data Bank data from 2007-2015 was used to identify patients with thyroid injury. Demographics, associated injuries, operative repair, complications, and outcomes were analyzed. Analysis was performed by odds ratio utilizing a logistic regression model.
Results: 1,395 patients with thyroid injury were identified from over 6.7 million trauma patients. Yearly incidence was 0.02%. The majority of patients were female (79.6%), had a penetrating mechanism of injury (79.7%), and had isolated thyroid injury (59.7%). The most common concomitant injuries were to the trachea (25.9%), carotid artery (9.5%), and cervical spine (7.9%). Operative interventions most frequently performed were direct thyroid repair (13.9%), thyroid blood vessel repair (3.4%), and thyroidectomy (3.2%). No patients experienced postsurgical hypothyroidism. All-cause mortality was 15.6%. After controlling for age ≥ 65, ISS > 25, and gender, non-isolated thyroid injury was shown to be an independent risk factor for mortality when compared to isolated thyroid injury (Odds Ratio 1.67, 95% Confidence Interval 1.17 – 2.34; p<0.05).
Conclusion: Thyroid injury in trauma patients is extremely rare. Interestingly, thyroid trauma is seen more often in females than males. Isolated thyroid trauma presents less of a clinical challenge with a lower risk of mortality than those with concomitant injuries even after controlling for significant covariates. When operative intervention is required, direct thyroid repair is greater than four times more common than thyroidectomy. Regardless of injury type and operation, postsurgical hypothyroidism was not seen.