Chymotrypsin-Trypsin Tablets for Post-Thyroidectomy Edema
There is no evidence supporting the use of chymotrypsin-trypsin enzyme tablets for managing edema after thyroidectomy, and they should not be used for this indication.
Evidence-Based Management of Post-Thyroidectomy Edema
The comprehensive 2022 multidisciplinary guidelines from the Difficult Airway Society, British Association of Endocrine and Thyroid Surgeons, and British Association of Otorhinolaryngology make no mention of proteolytic enzymes for edema management 1. This absence from major international guidelines is significant and indicates lack of supporting evidence.
Recommended Pharmacologic Interventions
For laryngeal and upper airway edema post-thyroidectomy:
- Intravenous dexamethasone should be considered to reduce upper airway obstruction and edema, though the effect is not immediate 1, 2
- Dexamethasone dosing of 0.15-1.0 mg/kg (maximum 8-25 mg) may be administered to reduce post-operative laryngeal edema 3
- Tranexamic acid should be considered to reduce bleeding, which indirectly helps prevent edema from hematoma formation 1, 2
Critical Focus: Hematoma vs. Simple Edema
The primary concern post-thyroidectomy is not simple edema but rather hematoma formation, which occurs in 0.45-4.2% of cases and can be life-threatening 1. The guidelines emphasize:
- Haemorrhage and subsequent hematoma most frequently occur within the first 24 hours, with approximately half occurring within 6 hours 1
- Routine drains do not prevent hematoma formation and may provide false reassurance 1, 2
- Management focuses on early recognition using the DESATS criteria: Difficulty swallowing/discomfort; increase in Early warning score; Swelling; Anxiety; Tachypnea/difficulty breathing; and Stridor 1, 4, 2
Monitoring Protocol (Not Enzyme Therapy)
The evidence-based approach prioritizes surveillance over pharmacologic edema management:
- Hourly observations for the first 6 hours postoperatively are mandatory 1, 2
- Patients should be nursed head-up to optimize airway patency 1, 4, 2
- Immediate supplemental oxygen administration if concerns arise 1, 4, 2
Why Proteolytic Enzymes Are Not Recommended
No high-quality guidelines or research evidence supports chymotrypsin-trypsin tablets for post-thyroidectomy edema management. The focus of modern thyroid surgery care is on:
- Prevention through meticulous hemostasis 5, 6
- Early recognition of complications 1
- Immediate intervention when airway compromise develops 1, 4
The use of unproven agents like proteolytic enzyme tablets may create false reassurance and delay appropriate monitoring or intervention for genuine complications like hematoma formation, which requires urgent surgical evacuation rather than pharmacologic management 7, 5.