Questions To Ask Your Doctor Before Thyroid Surgery
Duke doctors perform thyroid surgery on a patient at Duke Raleigh Hospital.
Your doctor may recommend surgery to remove part or all of your thyroid gland if its overactive, has grown very large, or has nodules, cysts or other growths that areor could becancerous. Here are essential questions to ask before you schedule thyroid surgery.
Learn more about thyroid cancer treatment at Duke.
What Are The Risks Of A Partial Thyroidectomy
You may bleed more than expected and need a blood transfusion. Your voice may be hoarse or weak after surgery, and this may become a long-term problem. Your neck may be bruised and swollen, and it may be hard for you to breathe or swallow. Your parathyroid glands may not work as well as they should after surgery. This can cause your calcium levels to drop too low. Low calcium levels can cause many problems, including an irregular heartbeat, muscle spasms, and seizures. This may be a short-term problem after surgery, or it may be a long-term problem.
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What Happens During The Procedure
The surgeon will make a cut in the front of the neck, 2cm to 3cm above the collar bone. They will divide the muscles so they can reach the thyroid gland.
They will be very careful not to damage the vocal cords or the parathyroid glands that sit behind the thyroid. These glands control the bodys calcium levels.
The surgeon removes the thyroid gland. The muscles are then put together and the wound is stitched to close it up.
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Further Treatment After Surgery
All tissue removed during the surgery is examined for cancer cells by a pathologist. The results will help confirm the type of cancer you have and determine whether you will require further treatment.
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.
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Why Is A Thyroidectomy Performed
Your doctor may recommend a thyroidectomy to treat a variety of diseases, disorders and conditions of the thyroid. Your doctor may only consider a thyroidectomy for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before having a thyroidectomy.
Your doctor may recommend a thyroidectomy for:
Benign thyroid tumors, nodules or cysts
or an enlarged thyroid gland. Surgery may be recommended for a goiter that interferes with breathing and swallowing.
when radioactive iodine and medications are not options
Thyrotoxicosis, also called thyroid crisis or thyroid storm, is a sudden worsening of hyperthyroidism that can be life threatening.
Watch Those Goitrogenic Foods
Certain foods, specifically cruciferous vegetables and products that have soy isoflavones, contain goitrogenic compounds chemicals that can interfere with thyroid hormones. A goiter is a swelling or enlargement of the thyroid, which can happen if the thyroid gland is functional and tries to grow more cells to keep up with the demand for hormones.
Because your thyroid is inactive, you don’t have to worry about a goiter forming, but you still have to account for the effect of the goitrogenic compounds on your supplemental thyroid hormones especially because you cannot naturally make more hormones to compensate.
Goitrogenic compounds in vegetables are often deactivated by heating don’t eat broccoli, cabbage or other cruciferous vegetables raw. Note that the goitrogenic effects of soy are lessened if the soy is fermented in products such as miso and tempeh.
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What Should I Expect After A Partial Thyroidectomy
Tell your healthcare providers if you have difficulty breathing or swallowing. Tell them if your bandage feels like it is getting tighter. You will have blood tests to check your calcium and thyroid hormone blood levels.
- Medicine may be given to bring your thyroid hormone level back to normal. A partial thyroidectomy means your thyroid gland can produce some thyroid hormone. You may need to take medicine daily to keep your thyroid hormone level steady. You may be given pain medicine after surgery. Radioactive iodine may be given if your thyroid gland was removed because of cancer. This medicine may kill cancer cells that were not taken out during surgery.
- Deep breathing helps open air passages and prevent a lung infection. Slowly take a deep breath and hold the breath as long as you can. Then let your breath out. Take 10 deep breaths in a row every hour while awake. You may be asked to use an incentive spirometer to help you with this. Put the plastic piece into your mouth and slowly take a breath as deep and as long as you can. Hold it as long as you can. Then let your breath out.
What Are The Side Effects Of Removing Your Thyroid
Some patients become hypothyroid following thyroid surgery, particularly when the entire thyroid gland is removed. This requires lifelong treatment with thyroid hormone replacement therapy.
Other side effects of thyroid removal surgery that may require patients to be re-hospitalized include:
- Tingling in the fingers that can progress to tremors
- Spasms in all muscles of the body, including the heart and muscles surrounding the lungs
- Low calcium levels
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How Much Of My Thyroid Will Be Removed
It depends on the reason for your surgery. If your thyroid is overactive , or the whole gland is enlarged and causing symptomssuch as a feeling of pressure or difficulty talking, breathing or swallowingthe whole thyroid should be removed in a procedure called total thyroidectomy, said former Duke endocrine surgeon Dr. Julie Sosa, MD. If only half your thyroid is enlarged and causing symptoms, but the other half is normal, then half should be removed, said Sosa.
For the most common type of thyroid cancer, which is generally low-risk, your doctor may recommend removing all or half your thyroid, depending on your circumstances. If you have intermediate- or high-risk cancermeaning it has spread outside the thyroidwe recommend total thyroidectomy, said Sosa.
Sophisticated imaging called neck mapping can help your surgeon determine ahead of time how much of your thyroid and which lymph nodes, if any, need to be removed. While not in use everywhere, neck mapping is routine at Duke. The best chance for a cure for thyroid cancer is making sure we remove all of the disease, said former Duke endocrine surgeon Dr. Sanziana Roman, MD. We dont want to overtreat, but we also dont want to undertreat. So knowing exactly how much surgery a patient needs is very important.
What You Must Know If You’ve Had Your Thyroid Removed
Surgical removal of the thyroid gland is referred to as thyroidectomy. Sometimes the entire thyroid gland is removed, while in other instances only part is removed. It is a fairly common operation and I see many such patients at my clinic. The thyroid gland may be removed due to thyroid cancer, enlargement or an over active thyroid gland caused by nodules in the gland. These nodules are called hot nodules because they over produce thyroid hormones. The thyroid can become over active as a result of Graves disease or hot nodules.
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Here Are Steps I Recommend Taking If You Had Your Thyroid Removed Or Ablated:
1. Support your adrenals this is probably the most important step you can take because adrenal imbalance can cause a wide variety of different symptoms such as:
A tendency to be a night personHair lossWaking up in the middle of the night with difficulty falling back asleepA slow starter in the morningFeeling keyed up and having trouble calming downLow blood pressureHeadaches after exercisingClenching or grinding your teethChronic low- or middle-back painDifficulty maintaining chiropractic adjustmentsPain on the medial side of the knee or kneesNeeding to wear sunglassesDizziness when you stand upDifficulty losing weightGaining weight around the waistlineGetting upset or angry easily
to learn 20 steps you can start taking today. I also have a free class about how to use essential oils to support your adrenals.
2. Eat a nutrient dense diet the foods you eat are a big factor in the health of the entire body. The right foods can help support your endocrine system, balance blood sugar, reduce digestive issues, and so much more. to read about the diet I recommend.
3. Keep an eye on your TSH levels TSH is a hormone that the pituitary sends out to tell the thyroid how much or how little thyroid hormones to produce. Some of this is dependent on the levels of fT4 in the body, but not always. In general, TSH levels tell you what your pituitary is up to, but its not telling you what the thyroid is doing.
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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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Treating Thyroid Gland Problems
If tests reveal a problem with your thyroid gland, you may receive treatment for:
- an overactive thyroid gland , which may include taking a type of medicine known as thionamides or a type of radiotherapy called radioiodine treatment
- an underactive thyroid gland , which usually involves taking a synthetic hormone called levothyroxine to replicate your normal thyroid function
What Are The Risks Of Thyroid Surgery
All surgery brings risk for complications like bleeding and infection. Thyroid surgery can also involve risks for damage to vocal cord nerves, which could cause hoarseness, and damage to your parathyroid glands, which are located behind and very close to your thyroid and regulate your bodys calcium levels.
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Complications Of Thyroid Gland Surgery
Surgery to remove some or all of the thyroid gland is usually safe, but as with all operations, there’s a risk of complications.
The risk of complications happening after thyroid gland surgery is estimated to be 1 to 2 in 100.
Before having the surgery, discuss the risks with your surgeon.
Infection, nerve damage and parathyroid gland damage are the main complications of thyroid gland surgery.
As with all surgery, there’s a risk of infection after thyroid surgery.
The thyroid gland is very close to the laryngeal nerves, which control your vocal cords.
If these are accidentally damaged during surgery, your voice and breathing could be affected.
Permanent damage to the laryngeal nerves affects 1 to 2 people in every 100 who have this type of surgery.
Temporary damage may affect up to 5 people in every 100.
Parathyroid gland damage
The parathyroid glands are tiny glands behind the thyroid. They help regulate the amount of calcium in your body.
If the parathyroid glands are damaged during thyroid surgery, you’ll probably need to take calcium supplements for the rest of your life.
Page last reviewed: 15 April 2019 Next review due: 15 April 2022
Who Performs A Thyroidectomy
The following specialists perform a thyroidectomy:
Otolaryngologists specialize in the treatment of diseases and conditions of the ears, nose and throat.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
Pediatric otolaryngologists specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.
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Will I Be Able To Lead A Normal Life After Surgery
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to do anything that you could do prior to surgery. Some patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone . This is especially true if you had your whole thyroid gland removed. Generally, you will be started on thyroid hormone the day after surgery, even if there are plans for treatment with radioactive iodine.
Are Thyroid Nodules Cancer
The vast majority more than 95% of thyroid nodules are benign . If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows.
Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. A thyroid fine needle aspiration biopsy can collect samples of cells from the nodule, which, under a microscope, can provide your doctor with more information about the behavior of the nodule.
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But What If Its Thyroid Cancer
A cancer diagnosis is always worrisome, but even if a nodule turns out to be thyroid cancer, you still have plenty of reasons to be hopeful.
Thyroid cancer is one of the most treatable kinds of cancer. Surgery to remove the gland typically addresses the problem, and recurrences or spread of the cancer cells are both uncommon. People who undergo thyroid gland surgery may need to take thyroid hormone afterward to keep their body chemistry in balance.
Whether its benign or not, a bothersome thyroid nodule can often be successfully managed. Choosing an experienced specialist can mean more options to help personalize your treatment and achieve better results.
Foods Containing Vitamin C
As you recover from surgery, eating a nutritious diet containing a wide variety of foods will aid your body in healing. In particular, vitamin C is necessary for healing wounds and forming scar tissue. Since vitamin C is water soluble, your body requires a continuous supply of foods containing this nutrient. Fruits and vegetables high in vitamin C include strawberries, raspberries, blueberries, broccoli, cauliflower, spinach, sweet bell peppers, and orange and tomato juices.
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What To Expect After The Procedure
After the operation is finished, the pulse, blood pressure and other vital signs will be monitored for a while. There may be a tube in the neck to drain fluid. This will probably be removed the next day.
You may be drowsy after the anaesthetic and take a few days to recover. Your voice may be hoarse or weak and you may have some pain in your neck. These symptoms normally go away quickly.
You will probably be able to go home the same day or the next day. However, dont do anything strenuous for 10 days after the surgery.
Removing Your Thyroid Gland
Thyroid surgery is done through an incision in the lower part of the front of your neck. It takes about 2 to 3 hours.
During your surgery, your surgeon will examine your whole thyroid gland and remove the parts that have cancer. Theyll also check the lymph nodes next to your thyroid gland and remove any that have or might have cancer cells.
- If half of your thyroid is removed, its called a lobectomy or hemi-thyroidectomy.
- If your whole thyroid is removed, its called a total thyroidectomy.
Your surgeon will talk with you before your surgery so you know what to expect.
There are 2 nerves very close to your thyroid gland that help your larynx work. These nerves are called the recurrent laryngeal nerve and the superior laryngeal nerve. They may be affected during your thyroid surgery.
- Your recurrent laryngeal nerve goes behind your thyroid to your voice box. If your tumor is close to this nerve or this nerve is injured during your surgery, your vocal cords could be damaged. This can make your voice hoarse. Voice hoarseness is common after thyroid surgery and usually goes away with time.
- Your superior laryngeal nerve helps you raise the volume and pitch of your voice. If this nerve gets weak or injured, the pitch and tone of your voice can be affected. This may make it hard for you to raise your voice or sing.
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