THYROID SURGERY: What you need to know and what to ask your surgeon

THYROID SURGERY: What you need to know and what to ask your surgeon

Introduction

The thyroid gland is an important gland in your body located in the lower half of your neck. It has a left side, a right side and a middle called the “isthmus.” It makes thyroid hormone and is responsible for regulating metabolism. Just like any other part of the body, sometimes things can go wrong with the thyroid that require its removal. Thyroid surgery is performed for non-cancerous reasons such as nodules (a solid or fluid-filled abnormal growth of thyroid cells that forms a lump within the thyroid gland) cysts, large thyroids (goiters) and an overactive thyroid (hyperthyroidism) as well as for cancers of the thyroid.

How much is removed depends on what is wrong with the thyroid and varies from as little as only the nodule, to one-half (left or right), to as much as the entire thyroid gland along with its lymph nodes (for advanced cancers). You should make sure to ask your surgeon why he/she is recommending you undergo thyroid surgery and how much of the thyroid gland he/she is planning to remove.

How Do I Know My Surgeon is Qualified to Perform Thyroid Surgery?

You should seek a surgeon who is experienced in performing the operation and feel free to ask how many thyroid surgeries the surgeon does each year. Surgeons who perform more thyroid surgeries generally have better results than surgeons who seldom do thyroid surgery. You can also ask if your surgeon has done fellowship training (a one- or two-year focused period of thyroid surgery and sub-specialization) (Editor’s Note: Surgical endocrine fellowships are relatively new. Therefore, very few senior surgeons have completed this training). You want a well-trained and experienced surgeon performing your operation.

Surgical Risks to Ask About

In general, there are three basic risks for any type of surgery: anesthesia, infection and bleeding. Fortunately these are unusual in thyroid surgery and occur less than two percent of the time. Other risks specific to operating on the thyroid include injury to the nerves that control your voice (the recurrent laryngeal [luh-rin-jee-uhl] nerves - you have one on each side of your voice box) or permanent damage to the parathyroid glands (tiny glands about the size of a couple grains of rice that control calcium levels in the body). Complications with injury to nerves and parathyroid glands are also very low, especially when the surgery is performed by an experienced surgeon. Injury to the nerves can result in a hoarse voice that may be permanent or temporary and last from several weeks up to six months - rarely does any further healing occur after six months, and any voice change is unlikely to recover without additional therapy. Damage to the parathyroid glands results in the inability to maintain calcium levels without taking calcium supplements and more than standard recommended amounts of vitamin D.

As with damage to the nerves, this can be temporary or permanent. The persistent need for daily calcium supplementation more than six months following surgery may mean that permanent damage or inadvertent removal of all of the parathyroid glands has occurred. These risks should be carefully discussed with your surgeon.

How Do I Prepare for Surgery and How is the Surgery Done?

Once you are scheduled for surgery, you will have a preoperative evaluation (complete medical exam) to ensure there are no medical problems that would prevent you from having a safe operation. You will receive specific instructions from your surgeon on this. Make sure to let your surgeon know if you are taking any medicines that can cause bleeding such as aspirin, blood thinners, or other medicines that affect platelets (cells in your blood that help make blood clots), such as ibuprofen (Advil) or naproxen (Aleve). Many surgeons ask that these types of medicines be stopped one week prior to surgery, if possible. Make sure to ask if you should take all of your other medicines on the day of surgery. The surgery is most commonly done through a one-to-four-inch incision near the base of the front neck while you are asleep under anesthesia. How large an incision is made depends on your surgeon, how big the thyroid is, and how much thyroid has to be removed.

After Surgery

Following thyroid surgery you may or may not be able to go home. If you stay in the hospital, it will usually be just for one night. You will have a sore throat both on the inside (much like when you have a sore throat from a cold) and at the incision site. Your greatest period of pain will last 48 hours post-surgery and then should improve. You will be able to eat and drink - most patients prefer to have some liquids in the first hours after surgery. You may have a bandage or tape covering the incision. Make sure to ask your surgeon when to remove it and when it will be okay to bathe after surgery. Most patients rest for several days after surgery. Ask your surgeon how much time you will need to recover.

What to watch out for

Very rarely an incision can become infected. Signs of infection are increasing redness, warmth and pain at the incision site. Also rarely, you can develop a hematoma [heema-toh-muh] (bleeding in the neck) after surgery. Signs of this complication are pronounced swelling of the neck along with difficulty breathing. If this happens, you should contact your surgeon immediately.

You may also temporarily have to take calcium and/or vitamin D after surgery. Signs of low calcium are tingling in all of the fingertips or around the mouth, as well as cramping and uncontrolled twitching in all of your arms and legs. This typically occurs one or two days immediately after surgery. If this happens you should contact your surgeon.

Do I Have to Take Medicine After Surgery ?

You should discuss with your surgeon when to restart your regular medication after surgery. If your entire thyroid gland was removed, you will have to take thyroid hormone replacement medication. You may be placed on thyroid hormone right away, but sometimes your doctor will wait to start thyroid medicine until the results (pathology) of the surgery are finalized (about one week).

If you are started on thyroid hormone medication, you will want to get your levels of thyroid hormone checked four to six weeks after starting the medicine. The medicine can be adjusted (increased or decreased) to obtain the proper levels. You should take this medicine at the same time each morning. If you had only half of your thyroid removed, there is still a chance you will need thyroid replacement medication, and you should have your levels checked as well.

Summary

Thyroid surgery is common and, when performed by experienced surgeons, is a very safe procedure with relatively quick recovery time. Remember to read about your particular thyroid disease before visiting with your surgeon. Also, write down questions to ask your surgeon and bring them with you to your appointment.

Dr. James Suliburk is an Assistant Professor of Surgery at Baylor College of Medicine in Houston, Texas. He is a board certified general surgeon, Fellow of the American College of Surgeons and completed fellowship training as the T. S. Reeve International Fellow in Endocrine Surgery at the University of Sydney Endocrine Surgical Unit in Sydney, Australia. His clinical interests include utilization of minimally invasive techniques to perform thyroid, parathyroid and adrenal surgery, as well as surgeon-performed ultrasound and use of molecular markers in the diagnosis of thyroid tumors.