Recuperating After Your Thyroid Surgeryby Mary Shomon Patient Advocate
Thyroid surgery — known as thyroidectomy — is most commonly performed to treat thyroid cancer, a significantly enlarged thyroid or thyroid nodules, and in some cases an overactive thyroid. If you’re having thyroid surgery, there are things you should know to help recuperate quickly.
Right after your thyroid surgery
In the initial hours after your thyroid surgery, you can expect to be in the recovery room for up to six hours, where you will be monitored for bleeding and given pain medication if needed. You will then be released to a room — or in the case of outpatient surgery, discharged from the hospital. According to the American Thyroid Association, most patients can manage post-thyroidectomy pain with over-the-counter pain medications.
Potential side effects after thyroid surgery
Thyroid surgery is considered safe, and there is generally a low risk of significant complications. However, there are some side effects that you may experience after surgery, including:
Some pain and/or stiffness in your neck from the incision, and from your neck position during surgery. Pain medication can help. The Medical College of Wisconsin recommends that you ask your doctor when you can begin gentle neck stretching exercises to help prevent neck stiffness after your thyroid surgery.
Sore throat, primarily because of the tube inserted in your throat to help you breathe while under anesthesia. After surgery, your doctor or nurse can provide lozenges, throat spray, or pain medication to relieve any throat pain.
A hoarse voice right after surgery, also from the breathing tube inserted during surgery.
A feeling like you have a lump in your throat.
These surgical side effects should go away in no more than one to two weeks. If you have vocal changes that continue past two weeks, you should be evaluated for laryngeal nerve damage, one of the few potential complications of thyroid surgery.
You may also notice some swelling and bruising, which should go away within six weeks.
Within 24 hours, your doctor will also check your calcium levels. This check is necessary because, during thyroid surgery, the manipulation of your parathyroid glands can cause hypocalcemia — a low calcium level — which requires calcium and vitamin D supplementation.
When to contact the doctor
If you notice significant swelling after you’ve been discharged, you should contact your surgeon right away, as this may be a sign of bleeding or infection. In addition to increased swelling, if you have any of the following symptoms after surgery, contact your surgeon immediately:
A fever that lasts more than 24 hours
Increasing redness and/or tenderness at the site of your incision
Caring for your incision and scar
After surgery, your doctor will close your incision with staples, absorbable sutures, surgical tape, steri-strips, and/or surgical glue, which you should leave alone until your doctor removes them. The doctor will usually cover the incision with a bandage. You should do your best to avoid getting the incision wet and stay away from swimming or soaking it in a tub. If your surgeon had any concerns about fluids or bleeding, he or she may also have inserted a drain into your incision. Your doctor will remove the drain a day or two after your surgery.
You may feel some numbness and itching around the incision scar in the initial weeks after surgery. This is normal.
After the doctor removes your stitches or staples, you can use scar creams and treatments to help minimize the scar's appearance. One helpful tip: use a sunscreen of at least 30 sun protection factor (SPF) for a year after surgery to help deemphasize and fade your scar.
Start thyroid hormone replacement medication
Many patients who have had a thyroidectomy are started on thyroid hormone replacement medication like levothyroxine (Synthroid, Levoxyl, Tirosint) immediately after a total thyroidectomy. There are two exceptions:
If you had surgery for thyroid cancer, in which case further treatment, such as radioactive iodine (RAI) may be needed. Your thyroid cancer specialist will determine when you should start thyroid hormone replacement, as well as the appropriate dose.
If you had surgery for Graves’ disease or hyperthyroidism. It can take several weeks for high circulating levels of thyroid hormone to dissipate. Your doctor will likely want to wait to start treatment until your levels have dropped.
If you were prescribed thyroid hormone replacement medication after surgery, you will typically require blood tests to evaluate your thyroid levels six to eight weeks after your surgery.
For the first few days after your surgery or discharge, you may find it less painful to eat soft foods that are easier to swallow.
The American Association of Endocrine Surgeons recommends that you avoid strenuous activity and heavy lifting for at least a week after you’re discharged. You should be able to drive within a week, but remember that it’s not safe to drive if you’re experiencing drowsiness from narcotic pain medication, or if you’re unable to turn your head.
The parathyroid glands, located next to your thyroid, control your body’s calcium levels. In a small percentage of cases, the manipulation of your parathyroid glands during surgery results in temporary or permanent damage to those glands. The resulting hypoparathyroidism — or slowed-down parathyroid glands — causes hypocalcemia, a condition of low calcium levels.
According to the Johns Hopkins Thyroid Surgery Center, the risk of damage to the parathyroid glands is greater if you’re having a full thyroidectomy, a multinodular goiter, or a repeat thyroid surgery, or if you’re having lymph nodes around the thyroid removed. If your surgery causes parathyroid damage, you will typically start experiencing symptoms within a few days of surgery. These symptoms can include:
Numbness and tingling around your mouth and in your lips
Numbness, tingling, and a crawling sensation in your hands and feet
Muscle cramps, muscle pain, and muscle spasms
Mood changes, including feeling more anxious or depressed
If you have these symptoms, contact your doctor right away. Your doctor will advise you on the appropriate dosages of calcium and vitamin D supplementation.
In most cases, if you have hypoparathyroidism, it will resolve quickly after surgery, usually within two months. In some cases, however, it can take up to a year to resolve. Your doctor will offer guidance on when to stop supplements. If you have permanent damage, you will need to remain on these supplements permanently.
Laryngeal nerve damage
Damage to your laryngeal nerves — the nerves that control your vocal cords and voice — is rare, but it can be a complication of thyroid surgery. If you have laryngeal nerve damage, you may experience symptoms such as:
A whispery, soft voice
Difficulty raising or projecting your voice
Hoarseness in your voice
These symptoms are usually temporary, and only a small percentage of people with these symptoms have any permanent damage.
Follow-up appointment with your surgeon
Typically, your surgeon will want to schedule a follow-up appointment with you within two to three weeks of your surgery. Your calcium levels may be rechecked at this point.