What to Expect When You're Expecting … Thyroid Surgery
Every time you have surgery, there is some trepidation, if not fear. Similar to flying in an airplane, you are trusting that someone else will take care of you for a few hours. It can make you nervous. In hopes of decreasing those fears, here is a brief overview of what to expect when undergoing thyroid surgery, from the risks you'll face to some thoughts on picking a surgeon and more.
First, and most importantly, you will need to find a surgeon you can trust. For the thyroid, specifically, there is some high quality evidence that more experience leads to better outcomes. We will come back to this topic in future posts, but it’s ok to ask your surgeon how many thyroid surgeries he or she does. He or she will answer specific questions, and let you know whether you will have inpatient (overnight) or outpatient (home a few hours later) surgery.
Usually, the surgeon will need to make sure that you are healthy enough for general anesthesia. This involves a physical exam and medical history, as well as some potential lab tests or imaging. Depending on your overall health, more or less testing may be needed. This can often be completed by your primary care doctor.
You may also have a list of medications or supplements that you should stop before surgery. Some examples include aspirin, other blood thinners, and some blood pressure medications. Do not stop any medication without speaking with the person who prescribed it, but do make sure that your medications are reviewed before surgery to make sure that none of them will increase your risks during surgery or while under anesthesia.
Finally, make sure not to eat or drink for at least the time prescribed by your surgeon or anesthesiologist. In the past, the standard was to not eat or drink anything after midnight the night before surgery. Speak with your surgical team to clarify what the policy is at your hospital.
Day of surgery
You can usually expect to arrive at least two hours before surgery to check in and make sure that you are ready for the procedure. It is important to have someone who can drive you home if you are going home the same day, because you will not be able to drive yourself.
At this point, your nerves may start to settle a bit, especially if the anesthesiologist provides something to help you relax. From then on, if everything goes to plan, the anxiety is over!
Congratulations! Usually, patients are grateful to be done with the anxiety of waiting for surgery, and the recovery is easier than they expected. During the first few hours after the procedure, you will be in the recovery room, groggily trying to come back to reality. You may need some lab tests, especially to check calcium levels.
If you are spending the night, your doctor may want to make sure that you are doing well before sending you home. He or she may have new medications (such as levothyroxine) that they want you to take. You may have a surgical drain to care for (which helps to remove excess fluid during healing following surgery), and you may need to learn how to care for your incision (all of this can be discussed before surgery).
Questions about pain and recovery are some of the most common that patients ask. In general, the good news is that thyroid surgery is very well tolerated by most patients. Usually, the worst complaints are a sore throat and a stiff neck. It is common for many patients to recover without taking any opioids or other narcotic pain medications after leaving the hospital. Don’t take any over the counter pain medications (such as ibuprofen or other NSAIDs) without discussing it first with your surgeon.
After you leave the hospital, the next phase of anxiety begins as you await the results from the pathologist. Most of the time it takes about a week to hear back. Your surgeon may choose to review these results with you in person, make them available online, give you a call, or some combination of each of those. If you have a drain or sutures in place, those will usually be removed within a week of surgery.
When you see your surgeon after surgery (usually anywhere from one to four weeks later), he or she will discuss your recovery to date, the pathology results, and any future treatment or surveillance plans. It’s another great time to ask questions.
Interestingly, this may be the last time that you see your surgeon. He or she will always be available, of course, but most of the post-operative surveillance (if you have cancer) or hormone adjustments will be completed by your endocrinologist or primary care doctor. Despite this fact, surgeons love to hear from their patients later in the recovery process, and even years later. While we especially like good news, all feedback is valuable, because we are always trying to improve. The appearance of the scar (if you have one) is one thing that surgeons pay particular attention to as time goes on.
As your surgeon steps out of the picture, your post-thyroid journey really begins. Be reassured that you are not alone. More than 100,000 people have thyroid surgery each year in the United States alone. There are people who are anxious to help you recover completely, and there are groups that can commiserate with you when it feels like recovery is slow or uneven. While any surgery can be a challenge, with the right team, you can expect to feel like you are being guided and encouraged at every step.
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