Surgery of the thyroid gland may be required to establish a diagnosis, relieve pressure from an enlarged thyroid, or to remove cancer. It is performed under general anesthesia (the patient is completely asleep) and usually requires at least an overnight stay. The hospital stay may be longer, depending on individual circumstances. While there are exceptions, most thyroid surgeries take from 1 to 3 hours.
A thyroid lobectomy involves removal of the half of the thyroid that has a nodule with characteristics suspicious for cancer. While the patient is still asleep, a “frozen section” is sometimes performed to analyze the tissue immediately. Ifthis preliminary evaluation indicates a high likelihood of cancer, the remainder ofthe thyroid is usually removed. This is known as a total thyroidectomy. Lymph nodes may also be removed as medically indicated, at the same time as the thyroid surgery. On the other hand, if the frozen section does not reveal cancer, surgery is completed without removing the other lobe of the thyroid gland. At the followup visit, the final pathology results will be discussed with the patient. In some cases, the final result is different than the preliminary result, and if it reveals cancer, this would require additional surgery.
Surgery is performed through a single incision in the front, central area ofthe lower neck. The surgeon will make every effort to make the scar less visible, but healing often depends on patient characteristics over which the surgeon has no control. A drain tube may be placed to prevent fluid accumulation under the incision. It may be removed the day after surgery, but it sometimes must remain in place for several days. Pain medications (and sometimes antibiotics) will be prescribed for use after surgery. Depending on the type of closure, sutures may be removed 5-7 days after surgery (or there may be surgical glue, which means no stitiched to remove).
Complications of surgery are not common. Bleeding, infection, scarring, numbness of skin, need for further surgery, and risks of anesthesia are general risks related to most surgeries. Hoarseness and difficulty swallowing because of injury to the recurrent and superior laryngeal nerves (nerves to the voicebox) occurs in less than 5% of cases. Hypocalcemia (low calcium) may occur from disruption ofthe blood supply to the parathyroid glands. This is usually temporary but may be permanent. This would require a lifelong daily calcium supplement. Some patients must take thyroid hormone replacement after surgery. If the entire gland was removed, this may be permanent.
Instructions for after surgery
- A follow up appointment should be made for about 1 week after surgery.
- Diet is usually normal by the time of discharge from the hospital
- Avoid lifting> 10 lbs, strenuous activity, and sports for 2 weeks. It is best to wear clothing that does not require being pulled over the neck, as it may be tender. There may be some swelling of the incision for a few days after surgery.
- Travel out oftown is not recommended until after the first visit after surgery.
- The incision should be kept clean and dry for 48 hours, after which time the patient may shower. (Do not apply any creams/ointments unless you are instructed to do so)
- Throat lozenges may be used for mild sore throat, hoarseness, or mild difficulty swallowing (these symptoms should improve in 3-7 days).
- Fever > 10l.5 F should be reported to the physician if it does not improve with Tylenol (be aware that the prescribed pain medications already have Tylenol) …It is helpful to have a number for a 24 hour pharmacy available after surgery, in case other meds are needed.
Please call us at 972-402-8404, extension 130 if you have any questions or concerns. Ask to speak to a nurse immediately if it is an emergency (trouble breathing, severe neck swelling or bleeding).