Thyroid Surgery FAQs
- What are the common reasons for the Thyroid Surgery ?
The most common reason for thyroid surgery is to remove a thyroid nodule, which has been found to be suspicious through a fine needle aspiration biopsy. Surgery may be recommended for the following biopsy results:
Surgery may be also recommended for nodules with benign biopsy results if the nodule is large, if it continues to increase in size or if it is causing symptoms (pain, difficulty swallowing, etc.).Surgery is also an option for the treatment of hyperthyroidism (Grave’s disease or a “toxic nodule”) for large and multinodular goiters and for any goiter that may be causing symptoms.
- cancer (papillary cancer);
- possible cancer (follicular neoplasm or atypical findings); or
- inconclusive biopsy;
- molecular marker testing of biopsy specimen which indicates a risk for malignancy.
- Are there other means of treatment ?
Surgery is definitely indicated to remove nodules suspicious for thyroid cancer. In the absence of a possibility of thyroid cancer, there may be nonsurgical options of therapy depending on the diagnosis. You should discuss other options for therapy with your physician who has expertise in thyroid diseases.
- How should I be evaluated prior to the operation ?
As for other operations, all patients considering thyroid surgery should be evaluated preoperatively with a thorough and comprehensive medical history and physical exam including cardiopulmonary (heart) evaluation. An electrocardiogram and a chest x-ray prior to surgery are often recommended for patients who are over 45 years of age or who are symptomatic from cardiac disease. Blood tests may be performed to determine if a bleeding disorder is present.Any patients who have had a change in voice or who have had a previous neck operation (thyroid surgery, parathyroid surgery, spine surgery, carotid artery surgery, etc.) and/or who have suspected invasive thyroid disease should have their vocal cord function evaluated preoperatively. This is necessary to determine whether the recurrent laryngeal nerve that controls the vocal cord muscles is functioning normally and is becoming a norm of practice. Finally, if medullary thyroid cancer is suspected, patients should be evaluated for coexisting adrenal tumors (pheochromocytomas) and for hypercalcemia and hyperparathyroidism.
- What are the risks of the operation ?
The most serious possible risks of thyroid surgery include:
Overall the risk of any serious complication should be less than 2%. Prior to surgery, patients should understand the reasons for the operation, the alternative methods of treatment, and the potential risks and benefits of the operation (informed consent).
- bleeding that can cause acute respiratory distress,
- injury to the recurrent laryngeal nerve that can cause permanent hoarseness, and breathing problems with possible tracheotomy in rare cases if injury is sustained on both sides and
- damage to the parathyroid glands that control calcium levels in the body, causing hypoparathyroidism and hypocalcemia.
- Will I need to take a thyroid pill after my operation ?
The answer to this depends on how much of the thyroid gland is removed. If half (hemi) thyroidectomy is performed, there is an 80% chance you will not require a thyroid pill UNLESS you are already on thyroid medication for low thyroid (Hashimoto’s thyroiditis). If you have your entire (total) or remaining (completion) thyroidectomy, then you have no internal source of thyroid hormone remaining and you will need lifelong thyroid hormone replacement.
- What can I expect once I decide to proceed with surgery ?
Once you have met with the surgeon and decided to proceed with surgery, you will be scheduled for your pre-op evaluation (see above) and will meet with the anesthesiologist (the person who will put you to sleep during the surgery). You should have nothing to eat or drink after midnight on the day before surgery and should leave valuables and jewelry at home. The surgery usually takes 2-2½ hours, after which time you will slowly wake up in the recovery room. There may be a surgical drain in the incision in your neck (which will be removed after the surgery) and your throat may be sore because of the breathing tube placed during the operation. Once you are fully awake, you will be moved to a bed in a hospital room where you will be able to eat and drink as you wish.
- What will be my physical restrictions following surgery ?
Most surgeons prefer a brief limitation is extreme physical activities following surgery. This is primarily to reduce the risk of a post operative neck hematoma (blood clot) and breaking of stitches in the wound closure. These limitations are brief, usually followed by a quick transition back to unrestricted activity. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days to 2 weeks.
- Will I be able to lead a normal life after surgery ?
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to do anything that you could do prior to surgery. Some patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone. This is especially true if you had your whole thyroid gland removed. Thyroid hormone replacement therapy might be delayed for several weeks if you are to receive radioactive iodine (RAI) therapy unless there is a plan for you to receive TSH injection prior to RAI.