1. (a) Thyroidectomy.

   1. (1) Acute airway obstruction requiring temporary tracheostomy (creation of hole in neck to breathe).
   2. (2) Injury to nerves resulting in hoarseness or impairment of speech.
   3. (3) Injury to parathyroid glands resulting in low blood calcium levels that require extensive medication to avoid serious degenerative conditions, such as cataracts, brittle bones, muscle weakness and muscle irritability.
   4. (4) Lifelong requirement of thyroid medication.

2. (b) For scarless/minimally invasive thyroidectomy.

   1. (1) All risks of standard thyroidectomy.

   2. (2) For axillary approach.

      1. (A) Injury to brachial plexus (nerves in shoulder/neck) which can affect function of muscles and sensation in the affected extremity.
      2. (B) Tract seeding of thyroid tissue (thyroid tissue can deposit and grow along the surgical tract).
      3. (C) Postoperative seroma (fluid collection in the area of the surgery).
      4. (D) Great vessel injury (injury to large blood vessels of the upper chest and neck).

   3. (3) Transoral/transoral vestibular approach (TOETVA)).

      1. (A) CO2 embolism (gas bubbles enter bloodstream) (Transoral/transoral vestibular approach (TOETVA)).
      2. (B) Mental nerve injury (nerve injury causing paresthesias (pins and needles sensation) of the lower lip and/or chin) (Transoral/transoral vestibular approach (TOETVA)).
      3. (C) Skin perforation (hole in skin) (Transoral/transoral vestibular approach (TOETVA)).
      4. (D) Burns (Transoral/transoral vestibular approach (TOETVA)).
      5. (E) Surgical space infection (Transoral/transoral vestibular approach (TOETVA)).

3. (c) Parathyroidectomy.

   1. (1) Acute airway obstruction requiring temporary tracheostomy (creation of hole in neck to breathe).
   2. (2) Injury to nerves resulting in hoarseness or impairment of speech.
   3. (3) Low blood calcium levels that require extensive medication to avoid serious degenerative conditions, such as cataracts, brittle bones, muscle weakness, and muscle irritability.
   4. (4) Persistent high calcium level with need for additional treatment/surgery.

4. (d) Adrenalectomy.

   1. (1) Loss of endocrine functions (lifelong requirement for hormone replacement therapy and steroid medication).
   2. (2) Damage to kidneys.
5. (e) For pituitary surgery, see §602.13 of this chapter (relating to Nervous System Treatments and Procedures).
6. (f) For pancreatic surgery, see §602.3 of this chapter (relating to Digestive System Treatments and Procedures).

Source Note:The provisions of this §602.5 adopted to be effective December 26, 2023, 48 TexReg 7985; amended to be effective May 25, 2025, 50 TexReg 2968.