Thyroid Surgery

The most common indications for thyroid surgery are thyroid cancer, other tumors that are difficult to discern from thyroid cancer, lumps or goiters causing symptoms, thyroid nodules that are easily seen on the outside of the neck, nodules larger than 4 cm, and hyperthyroidism that is not well treated by medication or radioactive iodine therapy.  Another reason for surgery can include open biopsy.

Surgery can be a hemithyroidectomy.  Only one side or lobe of the thyroid is removed.  This is usually for unilateral tumors that are not obviously malignant (follicular lesion of undetermined significance [link]), large nodules (larger than 4 cm), or visible nodules.  This may also be for “toxic nodules,” those that over secrete thyroid hormone.  Surgery usually takes 1-2 hours depending on many variables.  Risks are listed here [link to complications].  Some patients may need a drain after surgery.  Those that do not, may have the option of going home the same day of surgery.  Others will stay the night in the hospital.  The drain will be removed the next morning and you will go home.  If cancer is found by pathology, some will need to go back to the operating room for removal of the remaining thyroid.  On rare occasions, people with benign thyroid problems may need the other side removed.  We will check thyroid stimulating hormone 4-6 weeks after surgery to make sure the remaining thyroid lobe is making enough thyroid hormone

A total thyroidectomy removes the entire thyroid, or most of it.  Surgery lasts 1½ to 4 hours.  Risks of surgery are listed here [link to complications].  Nearly everyone stays the night after surgery.  This is for the drain and also to monitor the calcium in the blood.  We will need to check the blood calcium levels every 6 hours starting the day after surgery.  If they are stable, the drain is removed and you may go home.  You will go on high dose calcium supplementation to ensure that the calcium does not go too low.  This is tapered over 3 weeks.  You will need to be on thyroid hormone pills for the rest of your life.  

Post operatively, people will be on pain medication.  Fortunately, thyroidectomy is well tolerated.  The day of surgery, people may feel groggy, the throat is sore from the breathing tube place for surgery, and the neck may be stiff.  The pain may peak on post op day 1 but quickly subsides over the next several days.  Some may experience pain for longer and we can accommodate for this.  It is best to request 1-2 weeks form work.  Patients should not lift more than 10 pounds for 7 days; after that there are really no restrictions.  One should not drive or drink alcohol while taking pain medications.  People should be up and around the house as much as possible to keep blood pumping in the legs and to re-expand the lungs after surgery.  You will notice that your stamina may be temporarily diminished for 1-2 weeks.