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What To Expect After Thyroid Surgery

Recovery From Thyroid Surgery

What to Expect After Thyroid Surgery – James Wu, MD

After thyroid surgery, in most cases, a person will come back to their everyday life. The patient undergone thyroid gland surgery can also perform all normal and daily routines as usual.

But when it comes to strenuous activities, it is better to avoid them for ten days after the surgery.

For several days, a person may experience a sore throat. Doctors will prescribe all the necessary and required medicines for example over-the-counter pain medications such as ibuprofen or acetaminophen.

Such drugs will give some relief from throat soreness. In some cases, these common medications may not be enough, and doctors recommend narcotic pain medication.

In some cases, a person may develop hypothyroidism. So, when hypothyroidism is developed, doctors suggest taking some levothyroxine types to bring back the normal hormone levels.

To find the medications best dosage, the patient may have to undergo several blood tests and adjustments.

The recovery from thyroid surgery always depends on the type and extends of the surgery a person has undergone. The patient may take a long time recovering from open and traditional surgery than minimally invasive procedures.

After surgery, a person may experience:

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About Your Thyroid Gland

Your thyroid gland is a small, butterfly-shaped gland in the lower part of the front of your neck . It makes hormones that control the way your body turns oxygen and calories into energy. Your thyroid is made up of a left lobe and a right lobe. The area where the lobes join is called the isthmus.

Your parathyroid glands are 4 small glands located behind your thyroid. They make a hormone that helps control the level of calcium in your blood.

Lymph nodes are small oval or round structures found throughout your body. Theyre part of your immune system and make and store cells that fight infection. They also filter bacteria, viruses, cancer cells, and other waste products out of your lymphatic fluid.

Figure 1. Your thyroid gland

An Important Word About The Costs Of Treatment

Insurance rebates have not kept pace with the cost of running a medical practice. As a consequence, there will be a gap to pay for the surgical fee and for the anaesthetist. Your insurance company might also charge you an excess for a hospital admission. We will advise you about expected out-of-pocket costs not covered by insurance. If these costs represent an undue hardship for you, please discuss them with us.

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Thyroid Surgery Frequently Asked Questions

How long will I be hospitalized?

Most patients come to the hospital on the morning of their surgery and the majority of patients go home the same day after a 4 hour observation period in the recovery room.

What type of anesthesia will I have?

Patients will receive general anesthesia. With this type of anesthesia, you are completely asleep during the operation, and you will have a breathing tube placed temporarily to protect your airway and lungs.

Will I have a scar?

Yes. All surgery causes scarring, and how the patient heals the scar is very much dependent on the individual. However, there are some techniques that surgeons use to minimize scarring. These techniques include: a smaller incision size, careful incision placement, and using hypoallergenic suture material to avoid inflammation. Columbia Thyroid Center surgeons make every effort to place the incision in a natural skin line which acts like camouflage. The incision will blend into the skin line and once the redness fades away it is essentially invisible. As a general rule, you should not have a noticeable scar after six months. See Scar Gallery ยป.

Will I have pain after the operation?

When will I know the findings from the surgery?

During the operation, your surgeon may consult with the pathologist who will provide a preliminary diagnosis. However, the final pathology report requires careful study of your tissue specimen. Therefore, the final report is usually not available until about 1 week after the operation.

How To Help With Thyroidectomy Recovery

Ear Nose and Throat

1. Care the Scar

A coating is applied after the surgery to protect the incision from any damage. This coating must not be scrapped off while taking shower or cleaning the body. It will peel off on its own after a week or some days.

Once the coating of the scar peels off, one can apply a scar gel or cocoa butter for preventing the incision of getting dried. However, in some cases, swelling with or without bruises may appear if the coating is damaged during the first week of recovery. Special care must be taken then as this swelling can indicate presence of some infection.

2. Maintain a Healthy Diet

Consuming a healthy diet during the whole healing course plays a vital role in reducing the thyroidectomy recovery time. The body requires essential nutrients for healing purpose which can only be obtained through diet.

3. Quit Smoking

Smoking delays the healing of incision, a person must quit smoking in order to improve the circulation of blood towards the healing site.

4. Daily Routine Schedule

Following a healthy daily routine also helps with speeding up the recovery after the thyroidectomy. Get up in the morning, do light exercises then take meals on proper time. Such simple schedule can impact a positive change. Just have a try and keep it as a routine.

5. Support from Closed Ones

6. Build Activities Gradually

7. Tips to Remember During Thyroidectomy Recovery

Below are some considerations which must be followed for quick healing and recovery:

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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.

Why Choose Chop For Pediatric Thyroid Surgery

There are clear differences in how a child or adolescent is treated when care is provided in a pediatric setting compared to an adult setting. Childrens Hospital of Philadelphias Pediatric Thyroid Center is one of the few centers in the nation dedicated to the unique medical needs of children and adolescents with thyroid disease. Our center provides the ideal combination of experience and resources, so we can provide individualized care for your child.

Our Thyroid Center houses a multidisciplinary team that specializes in caring for children with thyroid problems. Our pediatric endocrinologists are internationally recognized leaders in pediatric thyroid disease. For children who require surgery, finding a pediatric-trained surgeon is critical to achieving the best possible outcomes while reducing the potential risks of surgical complications, specifically, damage to the parathyroid glands and the recurrent laryngeal nerves.

Why Choose CHOP for Thyroid Surgery

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How Many Days Off Work

They told me I could go back to work basically as soon as I could drive but that I should plan on being out of work a week or so.

My initial plan was to go back to work at 5 days post-op, and I couldve if I had to but I really wasnt ready.

I felt I could drive if I had to, but I wouldve been worried about turning my neck. Not to mention the fact that it would have been really uncomfortable all day at work.

I took a full week off from work actually went back to work the 10th day after surgery.

I was still feeling tired, and I was concerned about the amount of talking Id be able to do.

Pain Management At Home

What To Expect After Thyroid Surgery

Take NSAIDS like ibuprofen , naproxen or acetaminophen for the first 3-5 days as needed. Take medication as directed on the medication container. To prevent acetaminophen overdose, do not take acetaminophen when you are taking the pain reliever – Percocet – that was prescribed on your discharge from the hospital. They both contain acetaminophen. If you take the Percocet or any other narcotic – DO NOT drive a car or drink alcohol.

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Within 30 Days Of Your Surgery

Presurgical Testing

Before your surgery, youll have an appointment for presurgical testing . The date, time, and location will be printed on the appointment reminder from your surgeons office. Its helpful to bring the following things to your PST appointment:

  • A list of all the medications youre taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name and telephone number of your healthcare provider.

You can eat and take your usual medications the day of your appointment.

During your PST appointment, youll meet with a nurse practitioner . They work closely with anesthesiology staff . Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when youre discharged from the hospital. Theyll also help you care for yourself at home.

For caregivers

Exercise

Potential Complications & Side Effects Of Thyroid Surgery

As far as surgeries go, thyroid surgery is generally a very well tolerated operation which has a low incidence of complications.

The thyroid gland sits very close to the surface of the skin so it is relatively easy to get to without large or deep incisions.

Having said that, it’s worth exploring some of the potential consequences of thyroid surgery .

All in all, the risk of serious complications relating to thyroid surgery are typically less than 2%.

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Risks And Side Effects Of Thyroid Surgery

Complications are less likely to happen when your operation is done by an experienced thyroid surgeon. Patients who have thyroid surgery are often ready to leave the hospital within a day after the operation. Potential complications of thyroid surgery include:

  • Temporary or permanent hoarseness or loss of voice. This can happen if the larynx or windpipe is irritated by the breathing tube that was used during surgery. It may also occur if the nerves to the larynx are damaged during surgery. The doctor should examine your vocal cords before surgery to see if they move normally.
  • Damage to the parathyroid glands . This can lead to low blood calcium levels, causing muscle spasms and feelings of numbness and tingling.
  • Excessive bleeding or formation of a major blood clot in the neck
  • Infection

What To Expect In The Thyroidectomy Procedure

After thyroid surgery

The total length of the procedure is four hoursless if it involves removing only a portion of the gland. Here are the steps you may experience during the procedure.

1. Shrink the Thyroid

If you are a person with hyperthyroidism or thyroid cancer, the doctor may first shrink the thyroid using radioactive iodine. This makes the procedure easier to do and lessens the chance of bleeding during the procedure.

2. General Anesthesia

The thyroid gland removal can involve total or partial removal of the thyroid gland. In the vast majority of cases, the procedure is done under general anesthesia so you will not be aware of what goes on in the surgery. As with any surgery involving general anesthesia, you must not eat or drink anything from the night prior to the thyroidectomy procedure until the surgery has begun. Your surgeon will give you the exact instruction.

3. Removal of the Gland

The surgery is done by prepping the neck to make a two to four inch incision in the front of your neck where the thyroid gland is located. The surgeon will then remove the thyroid gland or part of the gland, taking care to leave the parathyroid glands intact, which are imbedded in the thyroid tissue.

4. Nerve Preservation

Nerves are retained when possible and only small arteries and veins are destroyed in order to lift out the thyroid gland. Nerve preservation is important because some nerves also control the function of the voice box.

5. Draining Fluids and Blood

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What To Think About

If you have a total thyroidectomy, you will develop hypothyroidism and need to take man-made thyroid hormone for the rest of your life. If you have a lobectomy or subtotal thyroidectomy, you may have hypothyroidism and you may need to take thyroid medicine for the rest of your life.

You will most likely be treated with radioactive iodine after surgery for thyroid cancer to make sure that all the thyroid tissue and cancer cells are gone.

You may have a lobectomy, with or without isthmectomy, if your doctor suspects that a nodule may be cancerous. If you do have cancer, a surgeon usually will do a complete thyroidectomy.

After surgery for hyperthyroidism, some people will have low calcium levels and may need to take calcium supplements.

Days Before Your Surgery

Follow your healthcare providers instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

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What Will Be My Physical Restrictions Following Surgery

Most surgeons prefer that patients limit extreme physical activities following surgery for a few days or weeks. This is primarily to reduce the risk of a postoperative neck hematoma and breaking of stitches in the wound closure. These limitations are brief, usually followed by a quick transition back to unrestricted activity. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days to 2 weeks.

When To Notify Our Office

What should I expect after thyroid surgery?

You should call our office at 410-328-6187 if you experience the following symptoms:

  • Fever with a temperature higher than 101.5.
  • Difficulty swallowing
  • Increase in pain at the incision that is not relieved by pain medication
  • Increased swelling, redness, or drainage from the incision
  • Numbness or tingling of fingers, toes, or around the mouth.
  • Muscle cramps

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Key Issues In Goiter & Thyroid Nodule

Whenever a person has a goiter or thyroid nodule, three questions must be answered.

  • Is the gland, or a portion of it, so large that it is stretching, compressing, or invading nearby structures? Thyroid swelling can cause a sensation of tightness or, less commonly, pain in the front of the neck. A goiter or nodule can compress the windpipe causing cough or shortness of breath, while pressure on the swallowing tube can cause discomfort with swallowing or even the inability to get things down. When a goiter extends down into the chest, blood returning from the neck and head can be partially obstructed, causing neck veins to bulge. When a goiter or nodule is due to cancer, the tumor may actually grow into nearby structures, causing pain, hoarseness when nerves to the voice box are invaded, or coughing up blood when the trachea is penetrated.
  • Third, is the goiter or thyroid nodule due to malignancy? Fortunately, most patients with a goiter or thyroid nodule do not have thyroid cancer. Often other findings in a patient with a goiter, such as the features of hyperthyroid Graves disease, make it unnecessary to do additional tests to rule out cancer. On the other hand, almost everyone with a thyroid nodule larger than 1.0 to 1.5 cm in diameter must be investigated for the possibility of thyroid cancer. The approach to these diagnostic evaluations is discussed below.
  • Table 2. Key Issues to Evaluate in a Person with a Goiter or Thyroid Nodule

    Your Diet During Recovery

    You can eat whatever you like after surgery. Try to eat healthy foods. You may find it hard to swallow at first. If so, it may be easier to drink liquids and eat soft foods such as pudding, gelatin, mashed potatoes, apple sauce, or yogurt.

    Pain medicines can cause constipation. Eating high-fiber foods and drinking plenty of fluids will help make your stools softer. If this does not help, try using a fiber product. You can buy this at a drug store.

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    Take It Slow Following Your Surgery

    It is important to understand that while routine, thyroid surgery is a major operation. Give yourself time to recover after having surgery. If you are under duress and worrying about your job or finances, talk to a relative, physician or seek aid. You will need the time to rest and recuperate as well as having some physical therapy after thyroid surgery to help regain flexibility in your shoulders and neck.

    While the time it takes to recover after thyroid surgery is different for everybody, rest assured that you should have no trouble returning to all of your normal activities once recovery is complete. As a general rule of thumb, most patients can return to work and mild exercise in two to three weeks unless lymph nodes were involved in the operation. If lymph nodes were also removed during the surgery it can take several weeks longer to fully recover and return to light activities. Heavy labour or contact sports should be avoided for longer in both cases and your physician will be able to guide you in deciding when it is okay to return to such activities.

    If you have questions or concerns about thyroid problems see your local doctor who will arrange for you to see a thyroid surgeon.

    For more information about thyroid surgery

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