Thyroidectomy

Mendy Maccabee, MD performs Thyroidectomy to remove of all or part of your thyroid gland, a butterfly-shaped gland located at the base of your neck. Thyroidectomy is done under general anesthesia through a horizontal incision at the collar line of the neck. This incision heals well with minimal scarring and provides safe access to identify the recurrent laryngeal nerves that control the vocal cords and remove all necessary thyroid tissue. Thyroid lobectomy is removal of one-half of the gland. A drain may be placed and is removed 1-7 days after surgery. If the entire thyroid is removed, you will stay in the hospital for a day or two. If only half the thyroid is removed, you may be able to go home the same day as surgery.

BEFORE SURGERY: No aspirin, Motrin, Ibuprofen, Advil, or any other anti-inflammatory medicine for one week before and one week after surgery. Also avoid Vitamin E, herbal supplements, herbal teas, and red wine for one week prior to surgery. Tylenol is permitted at any time. If you take Coumadin or other blood thinners please discuss this with your surgeon. Please do not eat or drink anything after midnight the night before surgery, but you may take any prescription medicines the morning of surgery with a sip of water. The hospital or surgical center will call you the day before with time and instructions for surgery. Make arrangements for a ride home after surgery. You will not be able to drive yourself home after surgery.

WOUND CARE: If your wound will be covered with tape strips and have dissolvable stitches under the tapes. Apply antibiotic ointment to the incision area 2-4 times a day. If you have a bulb type drain, empty the drain bulb at least 3 times a day (and every time it fills) and record the output. You may shower 48 hours after surgery. Pat the incision dry and apply a clean swipe of antibiotic ointment over the incision. If you have a drain do not shower until specifically instructed that it is ok by your doctor. The skin around the incision will be numb for several months after surgery. Three weeks after surgery, you may begin to massage the wound using vitamin E or aloe containing oil or lotion. This will soften the scar over time. Do not remove the tapes unless they fall off. You may trim any edges that start to peel off.

PAIN: The main complaint after surgery is pain when swallowing. Some people experience a dull ache, while others feel a sharp pain for a week or two. Take the medications as prescribed by your physician if you need something more than tylenol. Do not take Tylenol in addition to your prescribed pain medication as there is Tylenol in the pain medication as well. You may use plain Tylenol instead of the pain medication though.

VOICE: Your voice may go through some temporary changes with fluctuations in volume and clarity (hoarseness). Generally, the voice will be better in the mornings and “tire” toward the end of the day. This can last for variable periods of time, usually only several days, but can last several months.

DIET:  Expect to eat a liquid or soft diet for the first few days after surgery. If you find yourself coughing immediately after drinking, try thicker liquids or pudding consistency foods. If you continue to have this problem or if you develop chest discomfort or fever, let your doctor know. If a vocal cord weakness is present following surgery, a speech pathologist may be involved in selecting a diet that is appropriate. There are no restrictions to eating and if you are not having problems take a small bite to try something first. If there are no problems feel free to increase your diet accordingly.

THYROID HORMONE REPLACEMENT: If the entire thyroid gland is removed, you will need lifelong thyroid hormone replacement. If only a thyroid lobe is removed, you will probably not need thyroid pills. However, it is possible that over time, the remaining thyroid lobe can “wear out” and you may end up needing thyroid hormone replacement.

RISKS: • Bleeding—please do not take aspirin or Motrin (Advil or Ibuprofen) for one week before or two weeks after surgery. Bleeding under the skin after surgery can put pressure on your airway making it difficult to breathe. The wound could need to be re-opened and the bleeding stopped.

  • Infection
  • Reaction to anesthesia
  • Damage to adjacent structures
  • Voicebox nerve paralysis/weakness—The recurrent laryngeal nerve runs very close to or sometimes through the thyroid gland. It can be injured during surgery, this can cause hoarseness and usually resolves within several months, but may be permanent. If both nerves are damaged (very rare), you might require a tracheostomy (breathing tube in the neck) and a feeding tube
  • In about 8% of patients who have total thyroidectomy, the parathyroid glands (which control calcium levels) do not function properly immediately following surgery. This is usually temporary but does cause the calcium level in the blood to drop. Symptoms of low calcium include numbness and tingling in your hands, feet, and around your lips. These symptoms usually appear within 24-48 hours after surgery. It is rare for them to appear 72 hours or more after surgery. It is possible that all four parathyroid glands could inadvertently be taken out if the entire thyroid gland is removed, resulting in permanent low levels of calcium causing muscle, nerve and heart problems. Lifelong calcium and vitamin D replacement would be necessary.
  • Scar
  • Potential for other surgeries and treatments
  • Aspiration—food goes down the trachea (breathing tube)
  • Airway blockage—difficulty breathing
  • Hypothyroidism—tired feeling if not on adequate replacement medication, as well as constipation, weight gain, confusion, hair and skin changes, etc.

THYROID CANCER: Often we will not know before surgery if cancer is present. Rarely, we may find out during the surgery that a thyroid lobe has cancer in it; if so, we will remove the entire thyroid gland. More often we find out several days after surgery that cancer is present. If only one side was removed, we then have to take you back to the operating room about 6 weeks after the first surgery to remove the other half of the gland. If cancer is present, you may need a radioactive iodine treatment a few weeks or so after surgery to destroy any remaining cancer cells.

WHEN TO CALL THE DOCTOR: • Excessive bleeding • Signs of dehydration • Uncontrolled pain • Shortness of breath • Swelling and tightness in neck • Numbness in hands and lips • Excessive choking on food and drink

GENERAL INFORMATION• DO NOT drive, make important decisions, use power tools, drink alcohol, tend children, or climb ladders for the first day or two after surgery. Your judgment or alertness is probably seriously impaired. • Fainting or lightheadedness may occur. Use caution and move slowly when getting up from a bed or chair. • Avoid strenuous activities or lifting any object heavier than 20 pounds for the next 2-3 weeks. Avoid bending at the waist as much as possible. These may contribute to bleeding. • Call our office with any questions or concerns. • In case of emergency go to the nearest Emergency Room or call 911.

FOLLOW UP APPOINTMENTS ARE IMPORTANT
Please schedule your follow up appointment for one week from your surgery (if you have a drain 3 days after surgery). This is usually done at the time of your surgery scheduling or at your pre-operative appointment. If it was not please call to schedule or have them schedule when you are in the hospital recovering from your surgery.

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Hood River, OR 97031

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