August 2008

Thank you very much for your excellent Web site. It is easy to navigate and has a lot of very good information, including referral information. I would like to air one frustration, however; there does not seem to be much patient information regarding what to expect after a total thyroidectomy. As a health care professional for many years, and now 18 months post-thyroidectomy, I am surprised at the dearth of information regarding this issue. Except for calcium issues, there is very little on the Web. I would imagine the population needing this information would be relatively small, but it would make live so much easier knowing the emotional and physical aspects of your life that can be changed by this surgery and how to deal with these issues. Thanks again for your good work.

Thyroidectomy (surgery to removal all or part of the thyroid) may be required for patients with hyperthyroidism, goiter, thyroid nodules or thyroid cancer.

Thyroid operations can last from 45 minutes to 3 hours. The length of the operation is determined by whether one or both lobes are removed, and by the complexity of the operation. For example, it takes less time to remove a small thyroid nodule than to remove the whole thyroid and nearby lymph nodes in a patient with thyroid cancer. Depending upon local practice and the extent of the operation, patients may remain in the hospital overnight. Immediately after the thyroid operation, most people will have a sore throat from the breathing tube used for anesthesia.

Pain at the incision is minimal (most liken it to a sore throat), and patients generally require only mild pain medication (for example, acetaminophen) by the first day after the operation. It may be more comfortable to eat soft foods for a few days. Driving is not safe while taking pain medications that can cause drowsiness, and patients should not drive until they can turn their head comfortably from side to side (this may take up to a week). There may be some numbness around the incision immediately after the surgery; in most cases this resolves as the nerves in the skin heal. The wound healing sometimes causes itching that can last for several weeks. The incision will leave a scar, although these scars usually heal quite well. Patients should avoid sun exposure to the wound for about six months to improve the cosmetic outcome. Using vitamin E on the skin may also help to improve the appearance of the scar.

For most patients, walking and normal routines can resume the day after the operation, but vigorous activity and heavy lifting are not recommended for two weeks. Depending on their job type, most people will need to take 1-2 weeks off work after thyroid surgery. Some patients experience a sensation as though there is a lump in the throat upon swallowing; this is normal and it spontaneously subsides over time. Some patients may notice subtle voice changes or the voice may tire by the end of the day; these voice alterations generally resolve within 2-3 months. If voice changes persist, the surgeon or endocrinologist should be advised, as further evaluation may be necessary.

During the operation, the parathyroid glands (most people have four) are separated from the thyroid gland and hopefully preserved. However, the parathyroid glands may be located within the thyroid gland or attached to the thyroid capsule. Therefore, one or more of the parathyroid glands might be injured or removed. The parathyroid glands regulate the body’s calcium levels, and they can under-perform for several weeks after the operation. Therefore, the patients’ blood calcium levels are followed in the hospital and after discharge. Calcium, and sometimes vitamin D, supplements may be required, especially if both thyroid lobes are removed. In most cases, these supplements can be stopped within several weeks, once the parathyroid glands heal and their normal function returns. Patients require lifetime thyroid hormone replacement when the entire thyroid gland (both lobes) is removed, and sometimes when even just one lobe is removed. Patients who have some thyroid tissue remaining after the operation may not immediately need thyroid hormone, but they should be monitored periodically for the rest of their lives for the development of hypothyroidism. The endocrinologist will adjust thyroid hormone and calcium/vitamin D supplements, as indicated by blood tests.