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What to Expect After Thyroid Removal

Central to your recovery from thyroidectomy is pain control and knowing when to call the doctor about possible complications.
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Thyroidectomy

By

Sarah Lewis, PharmD

What is a thyroidectomy?

A thyroidectomy is the surgical removal of a diseased thyroid gland. Your thyroid gland is located in the front of your neck, below your larynx (voice box). It consists of two lobes, one on each side of your trachea (windpipe). Your thyroid gland plays an important role in regulating your body's metabolism and calcium balance. A thyroidectomy is a treatment for a variety of diseases, disorders and conditions of the thyroid gland.

A thyroidectomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a thyroidectomy.

Types of thyroidectomy

The types of thyroidectomy procedures include:

  • Lobectomy or partial thyroidectomy removes one lobe or only a portion of your thyroid gland.

  • Lumpectomy removes only a small portion of your thyroid gland. This procedure is a treatment for small, benign (non-cancerous) thyroid nodules or cysts.

  • Sub-total or near-total thyroidectomy removes almost all of your thyroid gland, leaving behind a very small amount of thyroid tissue.

  • Total or completion thyroidectomy removes all thyroid tissue. A completion thyroidectomy refers to the removal of any remaining thyroid tissue after you have had a previous lobectomy or partial thyroidectomy.

Other procedures that may be performed

Your doctor may perform other procedures in addition to a thyroidectomy. This includes a lymphadenectomy or the removal or biopsy sampling of lymph nodes. Your doctor may perform this procedure for confirmed or suspected thyroid cancer.

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 (non-cancerous) thyroid tumors, nodules or cysts

  • Goiter or an enlarged thyroid gland. Surgery may be recommended for a goiter that interferes with breathing and swallowing.

  • Hyperthyroidism (overactive thyroid gland) when radioactive iodine and medications are not options

  • Thyroid cancer

  • Thyrotoxicosis, also called thyroid crisis or thyroid storm, is a sudden worsening of hyperthyroidism that can be life threatening.

Who performs a thyroidectomy?

The following specialists perform a thyroidectomy:

  • Otolaryngologists (ENTs) 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 (pediatric ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.

How is a thyroidectomy performed?

Your thyroidectomy will be performed in a hospital or outpatient surgery setting. Your surgeon will perform a thyroidectomy using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an endoscope through a small incision in your neck. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery involves making a three to four inch incision in your neck. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different thyroidectomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your surgeon will perform a thyroidectomy using general anesthesia. In some cases, a thyroidectomy may only require local anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. 

  • Local anesthesia is also known as a nerve block. It involves injecting an anesthetic medication around certain nerves in the neck so you do not feel anything in the affected area. You will likely have sedation with local anesthesia to keep you relaxed and comfortable.

What to expect the day of your thyroidectomy

The day of your surgery, you can generally expect:

  • To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • To talk with the anesthesiologist or certified registered nurse anesthetist (CRNA) about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or CRNA will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a thyroidectomy?  

As with all surgeries, a thyroidectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.  

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing 

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs causing a pulmonary embolism.

  • Infection 

Potential complications of thyroidectomy

Complications of thyroidectomy include:

  • Damage to the parathyroid glands causing problems controlling your body’s calcium levels

  • Difficulty breathing, which is a rare complication

  • Nerve damage, which can lead to permanent hoarseness, coughing, swallowing problems, problems speaking, or other voice changes

  • Nerve irritation leading to temporary voice changes, hoarseness or weakness.

  • Temporary rise in the level of thyroid hormones

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Informing your doctor if you are nursing or if there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed 

  • Telling all members of your care team if you have any allergies

How do I prepare for my thyroidectomy? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for a thyroidectomy by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, other imaging studies, a fine-needle biopsy, a swallow study, bronchoscopy (windpipe evaluation), flexible laryngoscopy (vocal cord evaluation), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also need to take thyroid medications or iodine treatments for a couple of weeks before your thyroidectomy.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a thyroidectomy? Are there any other options for treating my condition?

  • Which type of thyroidectomy procedure will I need?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my regular medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

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 sore throat 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: