A thyroidectomy procedure is a surgical procedure that involves removing a portion or all of the thyroid gland. The thyroid gland is located in the front part of your neck and produces T3 and T4, the hormones that control cellular metabolism. Doctors do a thyroidectomy because the thyroid is overactive (a condition called hyperthyroidism), is enlarged (a condition called goiter) or has cancer within the thyroid tissue.
What to Expect in the Thyroidectomy Procedure
The total length of the procedure is four hours—less if it involves removing only a portion of the gland. Here are the steps you may experience during the procedure.
1. Shrink the Thyroid
If you are a person with hyperthyroidism or thyroid cancer, the doctor may first shrink the thyroid using radioactive iodine. This makes the procedure easier to do and lessens the chance of bleeding during the procedure.
2. General Anesthesia
The thyroid gland removal can involve total or partial removal of the thyroid gland. In the vast majority of cases, the procedure is done under general anesthesia so you will not be aware of what goes on in the surgery. As with any surgery involving general anesthesia, you must not eat or drink anything from the night prior to the thyroidectomy procedure until the surgery has begun. Your surgeon will give you the exact instruction.
3. Removal of the Gland
The surgery is done by prepping the neck to make a two to four inch incision in the front of your neck where the thyroid gland is located. The surgeon will then remove the thyroid gland or part of the gland, taking care to leave the parathyroid glands intact, which are imbedded in the thyroid tissue.
4. Nerve Preservation
Nerves are retained when possible and only small arteries and veins are destroyed in order to lift out the thyroid gland. Nerve preservation is important because some nerves also control the function of the voice box.
5. Draining Fluids and Blood
After the thyroid gland parts are removed, the surgeon will place a drain in your neck for a couple of days in order to drain fluids and blood from the surgical site. This prevents swelling of the neck. The drain is placed around sutures that close the rest of the skin cut at the outset of the surgery.
Potential Risks and Complications of the Thyroidectomy Procedure
Since the thyroidectomy is considered a major surgery, it has the risks of all surgeries, including problems with general anesthesia, bleeding complications and local or systemic infection. Other complications unique to a thyroidectomy can include the following.
1. Voice Change
If the surgeon cuts the wrong nerve, he could injure a common laryngeal nerve that supplies the voice box. This can damage the voice box so that you will have failure of the vocal cords to function and the voice will be hoarse. Sometimes, the nerve can be spared but voice changes happen anyway. Fortunately, your voice resolves itself in about 3-6 months. If the voice has not returned after the end of that time, speech therapists can help you regain your voice. There are special procedures done by an Ear, Nose, and Throat specialist that can also help restore your voice. There is about a one percent chance that voice changes will be permanent.
2. Damage to the Parathyroid Glands
There are four parathyroid glands imbedded in the back of the thyroid gland and the surgeon can inadvertently remove these glands when removing the thyroid gland. If even one of these glands is accidentally removed, there is a risk of hypoparathyroidism or a low parathyroid condition. Since the parathyroid glands regulate calcium metabolism, a condition of low calcium in the bloodstream can occur. About one percent of all patients undergoing a thyroidectomy procedure will have permanently low calcium levels.
3. Temporary Hypocalcemia
The calcium level can be temporarily reduced in about one third of all patients undergoing a thyroidectomy. When this happens, you can experience tingling and numbness around the lips and at the tips of your fingers. When calcium is supplemented, the symptoms usually go away and the calcium level remains normal.
After surgery, you should contact your doctor with any of these side effects or complications of a thyroidectomy:
- Bleeding at the site of the incision
- Localized swelling at the site of the surgery
- Fever of 101 degrees Fahrenheit or higher
- A sensation of warmth or redness in the neck
- Tingling of the lips, hands or feet
- A numb sensation in the lips, hands or face
Most of these complications are correctable if you call the doctor and get treatment for the surgical complication.
Recovery After the Thyroidectomy Procedure
There are things you can do to aid in your recovery from a thyroidectomy.
1. Take Care of Your Incision Area
After surgery has taken place, the incision will have to be taken care of. This may mean gently cleaning the wound daily and reapplying a gauze dressing. You may have restrictions on swimming, bathing or showering until the wound has healed. Follow your doctor’s instructions as how to take care of your incision site.
2. Avoid Heavy Lifting
It takes a couple of weeks for the wound to heal enough so that you can lift heavy objects. If your work entails lifting, you may need to be off work in order to decrease the stress on your neck incision. If your job does not include heavy lifting, talk to your doctor about what work restrictions you might have.
3. Do Gentle Neck and Shoulder Exercises
Following surgery, the neck area is likely to be swollen, numb and firm to the touch. It takes about a week before you can comfortably turn your neck without pain. Make use of a physical therapist, who will likely recommend that you undertake some gentle exercises to improve the range of motion of your neck. These exercises will help prevent prolonged neck stiffness. If the neck is still stiff after following the physical therapist’s instructions, talk to your doctor to see if anything else can be done.
4. Eat Soft Foods
During the time that your neck is still sore and stiffened, it is a good idea to eat soft foods that are not so painful to swallow. Chew your food carefully and eat at a slow pace. Drink water between bites so that you can avoid any type of blockage of the throat that can occur. Some people use a blender in the first few days after surgery in order to make solid foods pass through the throat more easily.
5. Check on Hormone Levels
When you have all or part of your thyroid gland removed, you are unlikely to have enough thyroid hormone in your body. This can cause problems with weight gain, slow metabolism, depression, dry skin, hair loss, cold feelings, muscle cramps, constipation, menstrual irregularities and decreased libido. There are blood tests that can tell what your hormone levels are like that can help the doctor decide what amount of thyroid replacement therapy you will need.
6. Take Thyroid Drugs
You may have to take thyroid replacement therapy for the rest of your life after thyroidectomy procedure. This involves taking small pills once a day that contain the missing hormones your body no longer makes.