What is a Thyroidectomy?
The thyroid gland is a butterfly shaped gland that sits in the middle of the lower neck. It produces thyroid hormone which regulates the body's metabolism. The thyroid gland can cause problems if it becomes enlarged, called a goiter, or develops a nodule. If the thyroid becomes too large it can cause problems
breathing or swallowing due to pressure from the enlarged gland on the voice box or esophagus (swallowing tube). If there is a nodule and it is malignant (cancerous) or suspicious then part or all of the thyroid should be removed. Fortunately, thyroid cancer is very treatable. Thyroidectomy is removal of all or part of the thyroid gland. A hemithyroidectomy removes half of the gland. A total thyroidectomy removes all of the gland.
What to do BEFORE surgery
Here are a few things you can do before surgery to help things go more smoothly:
- Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list--Medications to Avoid Prior to Surgery
- Stop smoking at least 3 weeks before your surgery date.
- If you/your child gets a chest cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia.
- One week prior to surgery blood counts, clotting levels, calcium levels will be checked. You will be provided a lab slip to have these drawn. Your insurance carrier may dictate the lab where the blood is drawn.
- No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery.
- Arrange for a ride home after the procedure if surgery is planned as outpatient.
What to Expect During Surgery
Thyroidectomy is performed under general anesthesia. With general anesthesia you will be asleep for the entire surgery. Surgical duration is highly variable depending on whether part or all of the thyroid is removed. During surgery intraoperative nerve monitoring (IOM) is performed. Nerve monitoring is a technique used to monitor the function of a patient's nerves during surgery. Nerve monitoring helps prevent damage to the nerves, reducing the risk of surgery-related nerve damage. Prior to surgery electrodes are attached to your body to monitor nerve pathways. A special computer is used by a technologist to read these signals. During surgery, an incision is made in a natural skin crease of the lower neck below the Adam’s apple. The thyroid gland is found as are the nerves to the voice box and the parathyroid glands. The nerves and parathyroid glands are protected, then part or all of the thyroid gland is then removed. If you are having surgery for a “suspicious” nodule, then your surgeon may obtain a frozen section—this is where the pathologist looks at your nodule under a microscope while you are asleep to better determine if there is cancer present. If the pathologist deems cancer is present the remainder of your thyroid would then be removed at that time. At the end of surgery, a drain may be placed to prevent blood or fluid accumulation under the skin. If only part of the thyroid gland is removed, you may be allowed to go home the same day. If the entire thyroid gland is removed, you will stay in the hospital overnight and most likely will go home the following morning. If a drain is placed, it is typically removed in 48-72 hours after surgery. Surgery is performed under general anesthesia.
What to expect AFTER Surgery
- Most patients are out of work/school for 1 week following surgery.
- Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
- Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain. AVOID NSAIDS (ex: Motrin) AND ASPRIN FOR TWO WEEKS AFTER SURGERY.
- A surgical dressing will be placed over your incision following surgery. After 3 days you may remove the clear plastic bandage and gauze. Leave the strip bandages in place.
- If you do NOT have a drain, you may shower as long as the clear plastic bandage remains in place. If it becomes soiled, loose, or is removed you may not shower for 72 hours after surgery.
- If you DO have a drain, you may not shower until the drain is removed.
- If you have a drain, the drain is placed prevent build-up of blood or fluid under your incision. The nursing staff will teach you how to care for your drain and measure its output. We recommend every 8 hours emptying the drain and recording the output. At the end of each 24-hour period total the output. Once the drain output is less than 35mL in a 24-hour period, call our office for removal. The drain must remain in place for a MINIMUM of 24 hours after surgery. Please do not call for removal until these conditions have been met. Premature removal of a drain increases the risk of wound infection and pain.
- Some mild hoarseness after surgery is not unusual. This is most commonly from the endotracheal tube used for anesthesia. Hoarseness following surgery usually resolves in 7-10 days.
- If there is redness, drainage, fever over 101 F or other concerns of infection, please notify us immediately.
- If excessive bleeding is noted, if you have sudden difficulty breathing or if there is rapid expansion of your wound, call 911 immediately.
- If you develop tingling of your lips, fingers, or toes or if your muscles feel spastic or cramping, notify us immediately.
- You will be seen 1 week after surgery to check the wound. If this appointment has not already been made for you then please call our office to schedule.
What are the risks of Surgery?
As with any surgical procedure, thyroidectomy has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
1) BLEEDING: Minimal bleeding is expected during and after thyroid surgery. Minor bleeding from the incision is typically not a problem; however, heavy bleeding deeper in the neck can be serious and can potentially cause difficulty with breathing.
2) HYPOPARATHYROIDISM OR LOW BLOOD CALCIUM: The parathyroid glands are small glands located around the thyroid gland. There are 4 parathyroid glands and these glands regulate the body's calcium level. Every attempt is made to identify and preserve these glands during surgery. Temporary or permanent drops in calcium levels can occur following complete removal of the thyroid. Your calcium levels will be monitored in the hospital and replacement given if levels are low.
3) DAMAGE TO THE NERVES THAT MOVE THE VOCAL CORDS:
The nerve(s) that moves the vocal cords runs right next to the thyroid gland. During surgery, these nerves are identified and carefully protected. Stretching or bruising the nerves can cause them to be temporarily weak which can result in hoarseness. Permanent damage to these nerves is rare which can result in persistent hoarseness. It is extremely unlikely that both nerves are injured. Unfortunately, if this occurs this can lead to difficulty in breathing, necessitating emergency airway control by tracheotomy.
4) INFECTION: Infection after thyroid surgery is uncommon but is most commonly treated with antibiotics or drainage.
5) POSSIBLE NEED FOR FURTHER TREATMENT AND/OR SURGERY: Once your thyroid is removed it will be sent to the lab to be examined by a pathologist. If a cancer is noted, further surgery or treatment may be necessary. This will be discussed with you by your surgeon.
6) NEED FOR MEDICATION: If your entire thyroid gland is removed you will need to take thyroid hormone supplements daily for the rest of your life. This will be prescribed by your physician following surgery. Thyroid hormone levels will need to be periodically checked, and dosages adjusted as indicated.
7) POOR SCARRING: We strive and normally achieve excellent scar camouflage. The scar is typically placed in a previous existing neck crease. Scars are typically raised, somewhat red and bumpy for several months after surgery. As they heal, the scar softens, matures, and becomes much less visible. Very rarely poor scarring can occur. In these rare instances, scar revision can be performed.
8) ANESTHESIA RISKS: As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even death are possible. Please discuss these risks with your anesthesiologist. Fortunately, with this procedure, anesthetic problems are exceedingly rare.