These are general instructions for patients. Individual circumstances vary so it is important that you discuss your individual post operative care with your thyroid surgeon.
The thyroid gland
- The thyroid is an endocrine gland located at the front of the neck below the larynx and around the trachea
- The thyroid gland produces thyroid hormone which has a key role in regulating many aspects of health and metabolism
- Iodine, an element found in many foods, is taken up by the thyroid to produce thyroid hormone
- Thyroid hormone helps regulate:
- Body weight
- Body temperature
- Heart rate
- Blood pressure
- Concentration
- Growth
Thyroid disorders
- Thyroid disorders are very common medical conditions
- They occur when the thyroid produces too much or too little thyroid hormone
- The thyroid may develop tumours which can be benign (non-cancerous) or malignant (cancerous)
- Many thyroid disorders can be treated with medicines, however, sometimes surgical removal of part or all of the thyroid is needed
Thyroid symptoms
Thyroid surgery may be needed when the thyroid is:
- Overactive (hyperthyroidism or thyrotoxicosis) and medical management is unsuccessful
- Enlarged or nodular producing a goitre
- Producing pressure symptoms causing breathing difficulties, choking, or the sensation of lump in the throat
- Cancerous or is suspected of being cancerous
- Enlarged and unsightly
- Growing into the chest
Which thyroid operation do I need?
- The extent of thyroid surgery performed depends on the specific thyroid condition being treated
- The goal is to treat the condition to the best extent possible, while maintaining the lowest risk
- Surgery will be recommended if the condition cannot be adequately treated medically, i.e. if cancer is found or suspected, if the airway is obstructed, or if medical treatment is unsuccessful
- Depending on the specific condition, the extent of thyroid surgery will vary from removing only one lobe of the thyroid, or half of the gland (this procedure is called a thyroid lobectomy or hemithyroidectomy – to removing the entire thyroid, called a total thyroidectomy
- Thyroid surgery may be performed through a standard neck incision or by a mini-incision (minimal access thyroid surgery) depending on the underlying thyroid condition
Total thyroidectomy
- Total thyroidectomy surgery removes the entire thyroid gland
- This is a safe operation with a minimal risk of damaging either the parathyroids or the laryngeal nerves
- There are several reasons why total thyroidectomy surgery may be needed including:
- Multinodular goitre
- Thyroid compression symptoms / Retrosternal goitre
- Hyperthyroidism
- Thyroid cancer
- Cosmetic reasons such as an unsightly lump in the front of the neck
Hemithyroidectomy
- Hemithyoidectomy surgery removes of one of the thyroid lobes
- Hemithyroidectomy is the minimum surgical procedure for adequate treatment of a solitary thyroid nodule
- This is a safe operation with a minimal risk of damaging either the parathyroids or the laryngeal nerves
- There are several indications for hemithyoidectomy surgery:
- Suspected thyroid cancer
- Compression symptoms
- Hyperthyroidism due to a solitary hyperfunctioning thyroid nodule
- Cosmetic reasons such as an unsightly lump in the front of the neck
Minimal access thyroid surgery
- Minimal access thyroid surgical techniques allow removal of part of the thyroid gland through a mini-incision approach
- This approach may be used for patients who require a hemithyroidectomy, thyroid isthmusectomy or local thyroid nodule excision
- Minimal access thyroid surgery is a safe alternative to open thyroid surgery for selected patients
After thyroid surgery
Monitoring Your Progress
- You should feel improvement every day after surgery
- If you have any questions regarding your progress, call your surgeon – a phone call to your surgeon’s office the first 2 days after your surgery to report how you feel can help your surgeon monitor your condition
- You will need to make a follow up appointment approximately 2 to 3 weeks after your surgery
Thyroid surgery incision
- Your incision is covered with a protective Steri-Strip
- You can shower and wash your hair as usual, but do not soak or scrub the incision
- After showering, use a cool hair dryer to dry the incision
- You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright
- The scar may become pink and hard – this hardening will peak at about 3 weeks and may result in some tightness, which will disappear over the next 2 to 3 months
Thyroid Hormone Tablets
- If you were taking thyroid hormone tablets before your operation, continue with the same dose, unless your dose is changed by your surgeon
- If you were not taking thyroid hormone prior to your operation, your surgeon will prescribe these tablets following surgery
- During your post operative visit, you may have a blood test to measure your levels of thyroid hormone and your dose of medication may be adjusted accordingly
- Your thyroid hormone levels will then be measured about every 2 months until your hormone levels are stable (levels generally stabilize in 4 to 5 months)
Pain after thyroid surgery
- The main complaint following thyroid surgery is discomfort with swallowing early on
- Some people experience a dull ache, while others feel a sharp pain
- This should not keep you from eating anything you want, but the pain can be annoying for a day or two
- Panadol is generally enough to control this pain. Some people prefer Panadeine or Panadeine Forte, but in general, strong medications are not necessary or advisable
Voice
- Your voice may go through some temporary changes with fluctuations in volume and clarity (hoarseness)
- Generally, your voice will be better in the mornings and “fatigue” toward the end of the day
- This can last for variable periods of time, but should clear in 8-10 weeks at most
- If you are hoarse, speak to your surgeon about what you can expect in terms of recovery
Cough
- If your operation was done under general anesthesia, you may feel like you have phlegm in your throat – this is usually because there was a tube in your windpipe while you were asleep that caused irritation that you perceive as phlegm
- You will notice that if you cough, very little phlegm will come up – this should clear up in 4 to 5 days
Hypocalcemia (low calcium levels)
- In a low percentage of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery
- Low calcium levels are usually temporary – symptoms 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
- Hypocalcemia is treated with calcium tablets, specifically 2 tablets of Caltrate 600mg daily – if you feel you need it, take the calcium (there is no danger in taking Caltrate even if you do not need it) and then call your doctor
- The symptoms of tingling/numbness should improve within 20 to 30 minutes of taking the tablets
- Once you start taking the calcium, you should repeat the dose whenever the symptoms return which may mean that you are taking as many as 2 tablets every 3 hours – it is important that you keep your surgeon informed
Bone Health
- Patients who are taking thyroid hormone tablets or who have a history of parathyroid disease should take 1000 – 1200 mg of calcium daily and 200 to 400 IU of vitamin D daily to promote healthy bones
- In addition to these supplements, an exercise routine using weights is also recommended
Thyroid surgery by an ENT – head and neck surgeon
- ENT – head and neck surgeons can provide a complete evaluation and treatment options regarding thyroid problems
- An ENT specialist can receive up to 15 years of university and post-graduate training in surgery, concentrating on ear, nose and throat procedures
- Because they study the complex anatomy, physiology, and pathology of the entire head and neck, ENT specialists are uniquely qualified to perform the procedures that affect the thyroid gland