What You Need To Know About A Thyroidectomy
The first line of treatment for papillary thyroid cancer, also known as papillary thyroid carcinoma, is to eliminate the cancer cells by surgically removing the thyroid. This procedure is known as a thyroidectomy.
Total Thyroidectomy There are 2 types of thyroidectomy procedurestotal and partial. A total thyroidectomy is a procedure that removes your entire thyroid gland. Total thyroidectomies are more common than their partial counterparts. That’s because total thyroidectomies provide a greater guarantee of removing the entire papillary thyroid cancer.
Total thyroidectomy procedures can take a long time to perform3 to 4 hours, in most cases. Your surgeon makes a small incision in the front of the neck, and he or she must carefully work around vital structures, such as the vocal nerves. A small amount of thyroid tissue near the recurrent laryngeal nerve may be left behind.
Because the thyroid gland is removed, this procedure causes hypothyroidism. Without the thyroid gland, no thyroid hormone is released. To compensate, you’ll need to take thyroid hormone replacement therapy. This will ensure that your body has healthy levels of thyroid hormones.
Partial ThyroidectomyFor patients with small papillary tumors located in only one lobe of the thyroid gland and whose cancer hasn’t spread outside the thyroid, a partial thyroidectomy may be enough to remove the cancer.
Hypocalcemia And Bone Health
Your bones have been starved of calcium during the time you have had hyperparathyroidism, and will now have the chance to grow strong again. After successful parathyroid surgery, I recommend plenty of dietary calcium. If you do not take at least three daily servings of calcium-rich foods, you may prefer to take Caltrate Plus twice a day to promote healthy bones. In addition to these supplements, an exercise routine using weights is also recommended. Your vitamin D should be kept >75 to enable your intestine to absorb the calcium in your diet.
In a small number of patients who have parathyroid surgery, the remaining parathyroid glands have become lazy, and do not function properly immediately after surgery. It is very rare after the mini-surgery, but about 5% if you need both sides of the neck explored. This is usually temporary and causes the blood calcium level to drop below normal . Symptoms of hypocalcaemia include numbness and tingling in your hands, soles of your feet and around your lips. Some patients experience a “crawling” sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours.
What Is The Recovery Like After Thyroid Surgery
- Immediately after surgery you will be sleepy for the first few hours
- You will be nursed with the head and neck supported to reduce swelling and strain on the neck
- Your nurse will show you how to do breathing and coughing exercises to reduce the risk of developing a chest infection
- An IV line will provide fluid until you are able to drink
- Most people recover reasonably quickly from thyroid surgery;
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Hoarseness And Voice Problems
After surgery, your voice may be hoarse or whispery, and it may feel tiring to talk. This is very common and expected during the first week or two after surgery. While around 1 percent of people may have damage to the nerves supplying the vocal cords, around 5 percent to 10 percent of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward.
Symptoms usually improve in the first few weeks but may persist up to six months after surgery. While there is no specific treatment for transient hoarseness, it’s helpful for your loved ones to be aware of the problem so that you don’t feel the need to talk loudly or more often than is comfortable. If the nerve was injured, more severe symptoms may be noted after surgery.
Why Is Parathyroidectomy Performed
Parathyroidectomy may be done if one or more of the parathyroid glands produce too much parathyroid hormone . It is usually due to a small noncancerous tumor of the parathyroid called an adenoma . Not all adenomas require surgery. The decides to operate based on the patients age, calcium levels in the blood and urine, and presence of symptoms. Cancer of the parathyroid gland is extremely rare. Parathyroidectomy is required in the cases of cancer as well.
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What To Expect The Day Of Surgery Commonly Asked Questions
A thyroidectomy can take anywhere from one to six hours once you are asleep depending on the type of surgery you are having.
- Most patients that undergo a total thyroidectomy will go home that same day after spending 5-6 hours in the recovery room.
- Patients with Graves disease, multiple medical problems, live far away, or are having a lateral neck dissection will spend one night in the hospital.
One of the rare side effects of thyroid surgery is injury to one of the recurrent laryngeal nerves that controls your voice. This complication occurs permanently in about 0.5-1% of patients. However, it;is not uncommon to experience some temporary hoarseness after surgery.
Yes. A nerve monitor is used during your entire thyroid operation. This allows the surgeon to confirm that the recurrent laryngeal nerve is working at the end of the case.
Care Of Your Incision
Your incision is covered with a waterproof protective dressing. You can shower as usual, but do not soak or scrub the dressing. After showering, pat dry. Often there will be a blood blister visible under the clear dressing. This is normal and no cause for alarm. Beginning five days after the operation, massage the scar for five minutes when you wake up, five minutes in the middle of the day, and another five minutes when you go to bed. There is good evidence that wound massage reduces pain and improves healing. Turn your head back and forth and roll your shoulders to reduce stiffness. ;Your dressing will be removed at your first post-operative visit. Most patients have sutures under the skin that dissolve by themselves. Replace the dressing with micropore tape and continue massage. Change the tape once a week. If you experience itching once the dressing is off, massage lotion into the scar. You might notice bruising around your incision. Your scar may become pink and hard, and your throat may feel tight. This hardening will peak at about 3-4 weeks, and will disappear over the next 3 to 4 months. You will also notice some numbness around the incision. This will gradually improve over time. You scar will continue to fade for 12 months. For best cosmetic results, keep it out of the sun.
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Recovery From Partial Thyroidectomy
Meeting with multiple surgeons results in potentially confusing the information regarding how long Id be out of commission. One surgeon told me that my down time would be 2 days . Another said a week. My surgeon;said that if I had a full time job outside the home, I should take off two weeks and if I worked from home on my own time, a week would probably be okay. As an otherwise healthy human, I figured that Id land somewhere in the middle.
Wrong. Two weeks is about right. I was pretty much useless during the first week. I could do a little bit here or there during the second week, but not much. I was back to full productivity during weeks three and four but I did need naps and was still unable to exercise. Unfortunately, I caught a horrible cold during week four and the coughing really irritated my surgical site. Do whatever it takes not to get sick for the first two months after surgery because it will set you back.
Otherwise, my surgeon;said people are back to;normal pretty much at about the six week mark.
Endometrial Bladder Urethral Venous Ablation
Endometrial, bladder, urethral, and venous ablations are similar to cardiac ablation in that where you have the procedure done and how long you stay will depend largely on the extent of the procedure and the type of anesthesia used. If you require general anesthesia or have complications during your surgery, you may have to stay in the hospital for an extra day or two.
In some cases, these procedures can be done with minimal or local anesthetic, and may even take place in your doctors office. This is particularly true for superficial or surface ablation procedures that are meant to fix minor imperfections or even out skin coloring.
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How Common Is Thyroid Surgery
For the most experienced surgeons at C/V ENT Surgical Group, having a minimum of 25 or more thyroid surgeries annually means they are experienced in the field. For many surgeons, this is one of the more common surgeries on their operating tables throughout the year than others.; Usually, general surgeons and head and neck surgeons/ENTs commonly perform these surgeries.
Neck Pain And Stiffness
The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.
Many surgeons recommend doing gentle stretching and range-of-motion exercises, such as the following, to reduce stiffness. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises she believes might be helpful, how often you should perform them, and whether there are any exercises you should avoid.
- Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
- Gently tilt your head to the right and then to the left.
- Rotate both shoulders forward in a circular motion.
- Slowly raise your arms overhead, and then slowly lower them back down against your body.
Suggested frequency: 10 repetitions, three times day
Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours does not, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation or a physical therapist who can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility to normal.
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How Much Does Thyroid Surgery Cost
For most patients and facilities around, the cost of thyroid surgery ranges based on exactly what was removed and what treatments were associated with the surgery. Each practice and facility will have its own costs associated with the surgery. Depending on your health insurance and your deductible for your plan, the cost could be more or less than other patients.; Usually costs out of pocket are less when these procedures are performed at surgical centers than hospitals.
Ensure that you reach out to your doctors office regarding the cost of this surgery and any payment options available for you, if necessary. They can give you a quote on your surgery and give you a real estimate of what you will owe after the surgery is complete.
What Can I Expect Once I Decide To Proceed With Surgery
Once you have met with the surgeon and decided to proceed with surgery, you will be scheduled for your pre-operative evaluation You should have nothing to eat or drink after midnight on the day before surgery and should leave valuables and jewelry at home.
The surgery usually takes 2-2½ hours, after which time you will slowly wake up in the recovery room. Surgery may be performed through a standard incision in the neck or may be done through a smaller incision with the aid of a video camera . Under special circumstances, thyroid surgery can be performed with the assistance of a robot through a distant incision in either the axilla or the back of the neck. There may be a surgical drain in the incision in your neck and your throat may be sore because of the breathing tube placed during the operation. Once you are fully awake, you will be allowed to have something light to eat and drink. Many patients having thyroid operations, especially after hemithyroidectomy, are able to go home the same day after a period of observation in the hospital. Some patients will be admitted to the hospital overnight and discharged the next morning.
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Thyroid Surgery Scar Will I Have A Scar
- Yes all surgery causes scarring, and how the patient heals the scar is very much dependent on the individual
- There are some techniques that may minimize scarring these techniques include using a smaller incision size and carefully placing the incision in a skin crease
- Appropriate post-operative wound care including using regular vitamin E cream and taping the incision for the first six weeks will reduce scarring
- Generally with appropriate wound care the scan will not be noticeable after six months
What To Expect After Thyroid Surgery
After thyroid surgery, you will probably stay in hospital for one or two nights to recover from surgery. Your neck wound will be closed with stitches, adhesive strips or small clips.
Your nursing team will talk to you about how to care for your surgical wound site once you go home to prevent it becoming infected. The surgeon may arrange blood tests to check on your recovery.
Most people who have thyroid surgery will feel better within 12 weeks, but recovery may take longer for some people.
For more on this, see;What to expect after thyroid cancer.
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When To Call Your Healthcare Provider
- You have a fever of 100.5 °F or higher.
- You have drainage from your incision.
- You have trouble breathing.
- The skin around your incision is warmer than usual.
- You have more discomfort in the area around your incision than usual.
- The area around your incision is more red than usual.
- You have new or increased swelling around your incision.
- You have numbness, twitching, or tingling around your mouth, fingertips, or toes.
- You have any questions or concerns.
Does Thyroid Surgery Leave A Scar
Like all surgeries that require an external incision, there is an initial scar from the incision made to remove some or all of your thyroid. Over time this scar will heal over 8 to 12 weeks and become barely noticeable if taken care of properly. For many patients, the scar will get so light over time that it is unrecognizable, especially if the scar treatment regimen and creams are followed.
When going out in the sun, however, you need to make sure that you place sunscreen and a cover over the scar for the first 6 months to avoid redness in the area. Any ultraviolet light that comes in contact with these incision scars will darken and can be noticeable. Most patients will either wear a scarf or a bandaid when going outside to cover the incision for the first 6 months.
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When To Seek Medical Attention
- Fever or chills
- Warmth, or increased redness/swelling/discomfort around your incision site
- Discharge from your incision site
- Numbness and tingling around your lips, fingers, or toes
If you experience signs of bleeding in your neck, such as trouble breathing, a high-pitched voice, or increasing swelling in your neck, seek emergency medical attention.
What Can I Expect After My Thyroidectomy
Knowing what to expect can help make your road to recovery after a thyroidectomy as smooth as possible.;
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may go home on the same day if you are recovering well and can swallow liquids. A hospital stay of one to two days may be required in some cases.;
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes two to four weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.;
When should I call my doctor?
It is important to keep your follow-up appointments after a thyroidectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
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What Are The Risks Of The Surgery
The most important risks that can be encountered during thyroid surgery are bleeding, damage to the nerve that stimulates the vocal cords that cause permanent voice changes, and damage to the parathyroid glands that regulate the calcium level of our body, which causes hypoparathyroidism. These complications are more common in large tumors with lymph node involvement and spread to the environment, in secondary surgeries to the thyroid gland, and in large goiters that extend towards the thorax. The complication rate increases when the surgeon’s experience is insufficient. In general, the complication rate should be below 2%.
Hypocalcaemia After Total Thyroidectomy Tingling And Numbness Of Fingers And Toes
In up to 50% of patients who have a total thyroidectomy, the parathyroid glands do not function properly immediately. This is usually temporary and causes the blood calcium level to drop below normal . Symptoms of hypocalcaemia include numbness and tingling in your hands, soles of your feet and around your lips, and can become quite unpleasant. Some patients experience a “crawling” sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours. Low blood calcium does not occur if only half the thyroid is removed.
Hypocalcaemia is treated with calcium tablets. If you are having a total thyroidectomy, I will check your parathyroid hormone before you leave hospital. If it is low, I will send you home with calcium and calcitriol , which will usually be temporary. If you develop tingling in the fingertips, toes, or lips, your calcium maybe low. Take two extra caltrate tablets The symptoms of tingling/numbness should improve within 30-45 minutes of taking the tablets. If the symptoms persist, you should take two more tablets and wait another 45 minutes. If they still persist after 3 extra doses, call my office in working hours, or after hours report to your nearest emergency room to have your blood calcium checked.