Your Doctor Recommended Thyroid Surgery

By Martha A. Zeiger, MD, FACS, FACE, and Helina Somervell, MSN, CRNP

Why surgery?

Thyroid surgery is done for many thyroid conditions, including thyroid cancer and sometimes non-cancerous thyroid conditions such as nodules, cysts, goiters (large thyroid glands), and overactive thyroid glands. The purpose of thyroid surgery is to remove part or all of your thyroid gland. Your surgeon will explain your operation and why he or she recommends it.

What are my potential risks of surgery?

Any surgery has risks. With thyroid surgery, there is a small risk of bleeding, infection, and injury to the vocal cord nerves. Injury to these nerves could affect your voice. Other risks include damage or accidental removal of the parathyroid [para-THIGH-roid] glands, which can result in a drop in blood calcium levels. A small risk is also associated with anesthesia. You should carefully discuss the risks and benefits of the surgery with your health care team.

How do I prepare for surgery?

Once you have decided to proceed with surgery, you will be scheduled for a pre-operative evaluation. The pre-op evaluation will include a complete medical exam. This can be done at your doctor’s office or at the hospital. Specific instructions regarding your medications and anesthesia risks should be discussed at this visit. If you take aspirin, blood thinners or non-steroidal anti-inflammatory agents, you should stop taking these at least one week before surgery in consultation with your doctor. The night before surgery, do not have anything to eat or drink after midnight. Get a good night’s sleep.

What will happen in surgery?

You will be asleep from the general anesthesia. Your neck is tilted back, a 2-4–inch incision (cut) is made at the base of the neck, and part or all of the thyroid gland is taken out. The operation generally lasts from two to three hours. After surgery you will stay in the recovery room for several hours where you will be watched closely as you come out of the anesthesia.

Can I go home after surgery?

Depending on the exact type of surgery you have, you will either be discharged home on the same day of the operation or you will stay in the hospital for one night.

What should I be on the lookout for after surgery?

A mild sore throat and some pain when swallowing is common for up to 7 days. The surgical tape will be removed at your post operative visit around 1-2 weeks. It is rare to get an infection. If you notice any redness or drainage from the incision, contact your surgeon. To make the scar less noticeable protect it with sunscreen that has a sun protection factor (SPF) of 30 for a full year. During the year, your scar might become raised or red but it will likely fade into a thin line which will be less noticeable.

I have been hearing about new surgical techniques for the thyroid. What is this all about?

A new technique called robotic thyroidectomy [thigh-roid-EK-tuh-mee] is accomplished through an incision under the arm so there will be no neck scar. Patients who have only one small thyroid nodule on one side of the thyroid gland, and no evidence of cancer that has spread to the lymph nodes. The potential complications are the same as the thyroid operation that is performed through a neck incision. If the other half of the thyroid has to be removed, the same procedure is done under the other arm.

Do I need to take any medications on a long-term basis?

You will need to be on partial or full thyroid hormone replacement, and in most cases this treatment is for life. You need a periodic blood test to adjust the dose of your therapy. Most endocrinologists [en-doh-cri-NA-lo-jists] believe that staying on the brand version, not generic, of thyroid hormone is best.

What about parathyroid surgery? Is this different from thyroid surgery?

The parathyroid glands make parathyroid hormone (PTH), which helps keep the calcium level normal. This is important for bone and other organs. There are usually four parathyroid glands, which are located next to the thyroid gland in the neck. Sometimes one or more parathyroid glands may be in a different part of the neck or in the upper chest. And rarely there may be a fifth or sixth gland. Hyperparathyroidism [hie-per-pa-ruh-THIGH-roid-is-m] occurs when the parathyroid gland(s) enlarge and make too much parathyroid hormone. This leads to calcium levels in the blood that are higher than normal. This can lead to other problems such as kidney stone or bone loss.

The purpose of parathyroid surgery is to locate and remove the abnormal parathyroid gland(s). When an experienced endocrine surgeon does the operation, up to 95% of hyperparathyroid patients can be cured. These surgeries are usually done as an outpatient, but some patients might have to stay in the hospital overnight.

Are risks for this surgery the same as for the thyroid?

The complications are similar to that of thyroid surgery. Rarely, all four parathyroid glands need to be removed and sometimes, a portion of one is transplanted into the forearm. Your surgeon will explain your specific surgery and why it is recommended in your case.

There is also the possibility that the abnormal glands could not be located or that your symptoms may recur over time. Occasionally, hypoparathyroidism [hie-po-pa-ruh-THIGH-roid-is-m] (low blood calcium levels) may result after surgery. You may experience numbness or tingling around your mouth or in your fingertips (usually within 24-72 hours). You will have to take calcium supplements as recommended by your surgeon for these symptoms until the symptoms resolve.

What should I expect after surgery?

The recovery and the care of the incision, and restrictions are similar to that of the thyroid surgery. Let your surgeon know about any changes you notice. At your follow-up visit, your surgeon will check how you are healing, and your calcium and intact parathyroid hormone levels will be checked through blood work. If these levels are stable, you will be followed up by your referring doctor. It is recommended that you have these tests repeated in about six months to verify that you are cured.

Dr. Zeiger is Professor of Surgery, Oncology, Molecular and Cellular Medicine, and is Chief of Endocrine Surgery at Johns Hopkins University School of Medicine.

Helina Somervell, MSN, CRNP, is a nurse practitioner in the Department of Surgery at the Johns Hopkins Hospital. Her clinical practice is in the outpatient management of endocrine surgery and melanoma and cutaneous oncology. She is a graduate of the Johns Hopkins University School of Nursing.