What should I do before surgery ?
What can I expect after the operation ?
What complications can occur ?
What will I need to know to go home ?
How long does it take for my incision to heal ?
How should I alter my diet after thyroid surgery ?
When can I go back to work ?
What are the long term consequences of removing the thyroid gland ?

What should I do before surgery ?

Preoperative Clinic Visit will include:

1. A History and Physical Examination:
   It is important to know your full health history and any and all of the medicines you take. Depending on your other medical problems, you may need to be seen by another specialist before your operation.
   
   
2. Blood work and Tests: According to your age, medical condition, and the type of surgery planned, you may be asked to have an EKG (heart tracing), chest x-ray, or blood work before your surgery.
   
   
3. Instructions for you and your family: We will explain what to expect on the day of surgery and answer any questions that you may have.  We will also give you written information with maps and phone numbers.  A doctor will explain the surgery and you will be asked to sign a Consent to Surgery form.
   
   
4. Anesthesia Evaluation: The anesthesiologist will see you on the morning of surgery if you are generally in good health.  If you have any serious medical conditions, we will send you to our preoperative anesthesia clinic.  Your record is then reviewed and the type of anesthesia is planned in advance.
   

Most patients are admitted to the hospital the day of the operation. You are usually required to have no food or drink at least 6 hours prior to surgery. This reduces the chances of you vomiting recently eaten food when you are being put to sleep, an event which could lead to life-threatening lung infections.

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What can I expect after the operation ?

How long does surgery last ?
The duration of the actual procedure varies between 90 minutes and 4 hours, depending on the extent of the operation.  In addition to the time required for the operation, the administration of general anesthesia prior to surgery and recovery from the anesthetic may require an additional 1-2 hours.

How long is hospital stay ?
Many patients require only an overnight stay in the hospital after surgery however a small number of patients may require hospital admission for 2-3 days.

After the Operation

• You will have a call light handy - let the nurse know if you need something!
• It is normal to feel tire, groggy and weak from the effects of anesthesia.  Do not get out of bed by yourself!  Ask for help.
• You will be asked to remain in a sitting position (in bed).  You will be able to move your head as you wish.
• You may also feel nauseated (sick to your stomach) and have some soreness and stiffness in your neck from the operation.  Medications will be available if you need them to relieve discomfort.  You must let the nurse know when you begin to feel uncomfortable.
• Some people will have a sore throat and/or hoarseness from the tube used for your anesthetic.  Ice chips or throat spray may help your throat feel better.
• You'll be checked frequently for signs of bleeding and swelling along the incision (some swelling is normal).  Your breathing and blood pressure will be checked as well.
• Depending on the type and extent of your surgery, we will look for signs of decreased blood calcium by obtaining blood samples to check the calcium level.

We may also:

• Tap on the side of your face to see if the muscles twitch.
• Ask if you have any numbness or tingling around your face or hands, or any muscle spasms.
• You will receive ice chips to start and then be given a clear liquid diet such as Jello or tea. Swallowing and eating may be difficult for a few days due to the swelling.  This is very normal and will improve.  Almost everyone experiences this to some degree.
• Later in the evening, you may walk to the bathroom or sit in a chair, but only with the help of a nurse to begin.
  
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What are the possible complications of thyroid surgery ?

Thyroidectomy is a safe and effective procedure. In addition to the complications associated with a general anesthetic such as stroke, blood clots (deep vein thromboses) and heart attacks, the specific complications of thyroidectomy are injury to nerves supplying the vocal cords (recurrent laryngeal nerve and superior laryngeal nerve), and inadequate function of the parathyroid glands after surgery.  The former complication may cause voice hoarseness or breathing difficulty, whereas the latter can usually be managed by taking calcium pills to augment blood calcium levels.  When identified during surgery, nerve injuries can be repaired and damaged parathyroid glands can be transplanted into the neck or forearm.  Another potential complication of thyroid surgery is bleeding into the neck after surgery.  This may occur suddenly and may require re-admission the hospital and/or another operation.  Scar complications such as keloids are rare and may occur during the weeks to months following surgery.

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What will I need to know to go home ?

1. A nurse will review discharge instructions with you and give you written instructions to take home.
2. You will be scheduled to see your surgeon in 1-3 weeks after your operation.  This will be in the same clinic in which you were seen before your admission.
3. When you leave, your wound will be covered by paper "Steri-Strips" which will remain in place until your post-operative clinic visit.  If they become unsightly or bothersome to you, you may remove them 10 days after your operation.
   
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How long does it take my incision to heal ?

1. Neck incisions heal rapidly.  They are watertight in about 24-36 hours allowing you to shower carefully.  The incision normally heals fully within a few weeks.  There is also swelling and a feeling of firmness under the incision that may last for a couple of months.
2. Most scars are most noticeable 1-2 months after operation and gradually become less so after several months. Until that time, you may notice the color is more red than surrounding skin.  This is normal and will improve.  However, this skin is sensitive to ultraviolet radiation so you should cover the incision with sunscreen when outdoors for extended periods of time to prevent darkening (hyperpigmentation) of the area.
3. If you wish, you may use vitamin E cream or other moisturizers on the incision.
   
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How should I alter my diet after thyroid surgery ?

There are no uniform general dietary restrictions for patients who have had thyroid surgery, however your surgeon may ask you to temporarily institute a low iodine diet if you need to receive radio-iodine treatment for cancer after thyroidectomy.

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When can I go back to work ?

Convalescence after thyroidectomy is usually short but depends on the extent of your operation.  Many patients return to an active work schedule within one week after thyroidectomy, however it may require up to 4 weeks to return to work after extensive neck exploration.  Consultation with your surgeon will determine when you can return to work after thyroidectomy.

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What are the long term consequences of removing the thyroid gland ?

Since most people have only one thyroid gland, removal of the thyroid requires life-long replacement of thyroid hormone.  This is easily accomplished in most patients with thyroid hormone pills (levothyroxine).  The medication is inexpensive and has few incidence of side effects. In addition, patients with thyroid cancer will require radio-iodine treatment after thyroidectomy and lifelong surveillance with a combination of blood tests and scans.

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