10 Questions You Should Ask Before Thyroid Surgery

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If you have thyroid cancer, problematic nodules or goiter, or less commonly Graves’ disease/hyperthyroidism or Hashimoto’s thyroiditis, your doctor may recommend thyroid surgery — known as a thyroidectomy. There are 10 questions you should ask before scheduling the surgery to remove all or part of your thyroid gland. Let’s take a look at these important questions.

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Are there any alternatives to thyroid surgery for my nodules or goiter?

Thyroid surgery is sometimes recommended for thyroid nodules in several situations:

  • When fine needle aspiration (FNA) biopsy of the nodule(s) is indeterminate or inconclusive, and thyroid cancer can’t be ruled out
  • When nodules are interfering with breathing or swallowing
  • When nodules or goiter are cosmetically unsightly

If you have indeterminate nodules, you may be able to avoid surgery by having the specialized Veracyte genetic test as part of a biopsy.

You may also be able to treat benign nodules with non-surgical treatments such as radioactive iodine (RAI), percutaneous ethanol injections (PEI), or high-intensity focused ultrasound ablation.

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Are there any alternatives to thyroid surgery for my thyroid cancer?

If you have a low-risk, small (1 cm or smaller in size), slow-growing papillary thyroid cancer, experts now recommend active surveillance — also known as “watchful waiting” — instead of surgery. John C. Morris, III, M.D., is a Rochester, Minnesota-based endocrinologist at the Mayo Clinic’s division of Endocrinology, Diabetes, Metabolism, and Nutrition. He has said that “If the thyroid cancer is not dangerous and won’t cause a problem, we can argue that any treatment is more than is actually needed.”

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How experienced is the surgeon?

Research shows that the more experienced the thyroid surgeon, the lower your risk of complications. You should choose an experienced surgeon who performs a minimum of 26 thyroid surgeries per year. The Columbia University New York Thyroid Center recommends that, ideally, you should choose a surgeon who performs a minimum of 50 thyroid surgeries per year, and who has performed at least 500 thyroid surgeries to date. Also, ask the surgeon his/her personal complication rate.

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How much of my thyroid will be removed?

You should ask the surgeon how much of your thyroid gland needs to be removed. While most thyroid surgeries are total thyroidectomies — removal of the entire gland — ask your surgeon if a lobectomy — removal of half the thyroid — is an option. If you have thyroid cancer, your surgeon may also perform a lymph-node dissection, removing some of some lymph nodes around your thyroid gland.

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What type of surgery will be performed?

Ask your surgeon how the surgery will be performed. Traditional thyroid surgery involves an incision in the neck — taking care to place the incision in a neck fold to minimize the scar’s visibility. If your surgery is not for thyroid cancer, however, you may be a candidate for robotic axillary (underarm) surgery. According to Duke Health endocrine surgeon Michael Stang, M.D.: “Some patients are candidates for this procedure, as long as the thyroid isn’t too big.”

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Will this be outpatient surgery, or will I be hospitalized?

Depending on the extent of the surgery and your health status, you may have thyroid surgery as an outpatient, or you may be hospitalized for one or more days after surgery. The issue of whether outpatient thyroidectomy is as safe as hospitalization is controversial, and is worth discussion with your surgeon. In particular, if you are discharged soon after surgery, have a plan in place to deal with any post-operative complications such as bleeding, infection, or hypoparathyroidism.

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How should I prepare for surgery?

You should ask your surgeon what specific preparations you should make before surgery. For example, you will typically be told not to eat or drink anything after midnight the night before your surgery.

Also, be sure to ask about any supplements and prescription medications you are taking, and if you should continue taking them before and up to your surgery. (You will usually be advised, for example, to stop taking aspirin or blood-thinners like Coumadin, Plavix, or Eliquis for a week or more before surgery.)

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What symptoms or complications should I watch for after surgery?

You should review with your surgeon any signs or symptoms of complications that may arise after your surgery, and what you should do. For example:

  • Bleeding, fever, and significant pain should be evaluated immediately.
  • Voice changes and hoarseness are common after surgery and usually resolve on their own.
  • Numbness and tingling in the fingers and mouth and muscle cramps can be signs of hypoparathyroidism, a complication of thyroid surgery. Your doctor should instruct you on a plan of action, including the appropriate dose of calcium and vitamin D to take in the event this occurs.

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What follow-up is needed after my surgery?

Before surgery, you should schedule a follow-up visit to remove any stitches or staples after your thyroidectomy.

Your surgeon should advise you regarding your recuperation after thyroid surgery, including when you can go back to work, exercise, sports, and regular activities, including driving. You should also ask about protecting your scar after surgery, and how to care for your scar to minimize the appearance.

If you had thyroid cancer, you will also want to find out when the detailed pathology assessment will be available, so your cancer can be staged and a plan for further treatment outlined.

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What is the plan for thyroid hormone replacement?

After thyroid surgery, you will most likely be hypothyroid and require lifelong prescription thyroid hormone replacement medication like levothyroxine or natural desiccated thyroid. Before your surgery, you should discuss with your physicians the plan for when to start your medication, which medication will be prescribed, and a plan for periodic blood testing and monitoring to ensure that you are getting the optimal dose.