Recovery from thyroid surgery, side effects and complications.

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If you are having thyroid surgery, known as a thyroidectomy , it is important to know what to expect after you recover. Side effects of surgery are common and include neck pain, sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism.

Complications are much less common and can include bleeding (neck hematoma), persistent hypoparathyroidism (requiring long-term calcium supplements), and nerve damage that can lead to long-term hoarseness and voice changes.

Taking the time to learn about thyroidectomy recovery can help you learn to deal with any symptoms and be prepared for any problems.

Side effects

There are a number of short-term side effects that people can experience after thyroid surgery. Most of them will be temporary, but some may persist. Common side effects that begin after surgery include :

Nausea and vomiting

At one time, nausea and vomiting after thyroidectomy were the norm, and people may be concerned if they talk to other people who have had this procedure before.

Fortunately, the use of medications such as dexamethasone has significantly reduced the frequency of vomiting, and if nausea occurs, there are treatments that can alleviate your symptoms.

Neck pain and stiffness

During the operation, the neck is in an extended position and many people avoid turning the neck afterwards. This can lead to pain and stiffness in the neck. Using pain relievers after surgery can reduce discomfort by making it easier for you to move your neck, and you will have less stiffness later. A warm compress can also help.

Many surgeons recommend light stretches and range-of-motion exercises, such as the following, to relieve stiffness. However, before doing this, be sure to ask your surgeon if they are right for you, what additional exercises you think might be helpful, how often you should do them, and if there are exercises you should avoid.

  • Turn your head gently to the right, then turn your head so that you are facing the ground, then gently turn your head to the left.
  • Tilt your head gently to the right and then to the left.
  • Roll both shoulders forward in a circular motion.
  • Slowly raise your arms above your head and then slowly lower them towards your body.

Recommended frequency: 10 repetitions three times a day.

Most often, neck stiffness persists for days or weeks after surgery. If you haven't already, talk to your surgeon about seeing a physical and rehabilitation (physical therapist) or physical therapist who can work with you to improve your neck flexibility and develop an exercise program to restore your neck to mobility. normal. …

Throat pain

Thyroid surgery is often performed under general anesthesia, in which a breathing tube is placed in your windpipe so that you can breathe for yourself. This can cause a sore throat and a feeling of a lump (like something is stuck in the throat) when swallowing. Using a throat spray or lozenge can help ease the discomfort until you recover.

Difficulty to swallow

Swallowing problems ( dysphagia ) are common symptoms after thyroid surgery, although they are usually temporary. It is helpful to eat soft foods for the first few days. Examples include foods with sauces or juices, cooked vegetables, and casseroles.

Hoarseness and voice problems.

After surgery, your voice may be hoarse or whispery, and talking can be tiring. This is very common and is expected within the first to two weeks after surgery. While about 1 percent of people may have damage to the nerves that supply the vocal cords, 5 to 10 percent of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the the nerves later.

Symptoms generally improve in the first few weeks, but can persist for up to six months after surgery. While there is no specific treatment for transient hoarseness, it helps to make your loved ones aware of the problem so that you do not feel the need to speak out loud or more often than you are comfortable with. If the nerve has been damaged, more serious symptoms may be noted after surgery.

Get Medication Information / Brianna Gilmartin

Transient hypoparathyroidism

All four parathyroid glands are located at the back of the thyroid gland and are sometimes damaged or removed during surgery. These glands are responsible for controlling calcium levels in the body. However, even if these glands are intact, about 5 percent of people may have temporary symptoms of low calcium levels (hypocalcemia), which can persist for up to six months.

Because the parathyroid glands generally do not work well after thyroidectomy, you may be sent home with calcium and vitamin D supplements. When you have your return visit, your surgeon will monitor your blood calcium levels. If you are not given calcium, it is important to be aware of the symptoms of hypocalcemia, which often include numbness and tingling in the mouth and fingers.

Most of the time, calcium levels improve after a few weeks, but can remain low for up to six months. During this time, your healthcare provider will monitor your calcium levels to determine when you can stop taking your supplements (or, much less frequently, if you need to continue them indefinitely).

A 2018 study found that potassium iodide administration during thyroid surgery was associated with less transient hypoparathyroidism and hoarseness (and may increase the safety of the procedure for people with Graves' disease). You can ask your surgeon about this before surgery.

Hypothyroidism

People who have undergone a complete thyroidectomy will need prescribed thyroid replacement therapy after the procedure. With subtotal thyroidectomy, hypothyroidism is less common, affecting about 20 percent of people who have this procedure.

If your doctor prescribes thyroid replacement therapy, be sure to talk with her before you leave the hospital about when to start taking your medications, what medications you need, and in what doses. It is also important to talk about how to take your medications correctly , as food, many medications, and supplements can interfere with absorption.

If you've had a subtotal thyroidectomy and haven't started taking thyroid hormone medications right away, watch for symptoms of hypothyroidism closely and contact your doctor if they arise. Regular thyroid testing is also important, as hypothyroidism may not develop right away or even for several months or years.

There are many symptoms of hypothyroidism, but some of the most common include:

  • Cold sensation, especially in the extremities.
  • Dry and rough skin
  • Excessive or unexplained weight gain
  • Fatigue and sluggishness
  • Constipation
  • Muscle spasms
  • Increased menstrual cycle and increased menstruation.
  • Depression and difficulty concentrating.

Thyroidectomy recovery stories from 3 different patients

Complications

Although thyroid surgery is considered a relatively safe procedure, complications can sometimes arise. Some of them require immediate treatment, so it is important to know their potential.

Hematoma

Bleeding into the tissues around the neck (neck hematoma ) is rare but life-threatening if not diagnosed and treated right away. Occurs in about one in 300 procedures, most bruising occurs within 24 hours after surgery, although studies show it can occur later in 10 to 28 percent of cases.

Symptoms may include a lump and swelling in the front or side of the neck (usually below the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, dizziness, or stridor (a high-pitched whistle that is usually more perceptible on inspiration than on expiration).

If you experience neck swelling, increased pain, shortness of breath, or shortness of breath, seek medical attention immediately.

Treatment includes immediate surgery to remove the hematoma and correct the bleeding.

Persistent hypoparathyroidism

Although temporary in some cases, hypoparathyroidism caused by damage or removal of the parathyroid glands can be permanent. Because only one in four parathyroid glands is needed to regulate calcium levels, this condition is rare, affecting about 2 percent of people who have undergone thyroidectomy .

Factors that increase the risk of hypoparathyroidism after thyroid surgery include a diagnosis of thyroid cancer, longer-term thyroid disease before surgery, a central incision, and the removal of a large amount of thyroid tissue.

If calcium supplements are not used and the condition remains constant, additional symptoms may include tingling and numbness in the feet, muscle cramps and spasms, anxiety, depression, and headaches. If the hypocalcemia is severe, the condition can progress to symptoms of irregular heartbeat (arrhythmias), shortness of breath (due to muscle spasms in the larynx), kidney stones, heart failure, and / or seizures. As with other side effects and complications, the timing of symptoms may vary from person to person.

Most of the time, all that is required is a lifetime calcium intake. However, if severe symptoms appear, intravenous calcium may be required in the hospital.

Laryngeal nerve injury

Less than 1 percent of people who undergo thyroidectomy will experience damage to the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. If hoarseness persists, especially if it persists six months after surgery, the recurrent laryngeal nerve may be damaged. This nerve controls the muscles that move the vocal cords.

In addition to persistent hoarseness , recurrent laryngeal nerve damage can lead to other symptoms after surgery. These can include uncontrolled coughing when speaking, shortness of breath, or aspiration pneumonia.

If any of these symptoms appear, an immediate examination by a physician or ENT specialist is recommended. Your ENT doctor will perform a procedure called direct laryngoscopy to view your vocal cords and find out if a tracheostomy is necessary. It is rare and is primarily a concern if both nerves are damaged.

Damage to the external branch of the superior laryngeal nerve is usually less obvious. If injured, it may be difficult for a person to make loud tones or scream, although their normal voice may not change.

Infection

The risk of infection is present with any type of surgery, but is relatively rare with thyroid gland surgery (approximately one surgery in 2000). Treatment generally includes intravenous antibiotics.

Seroma

A seroma is a collection of fluid that can form after many types of surgery. Although the body often reabsorbs fluid, large seromas may need to be drained.

Thyroid storm

Thyroid storm or thyrotoxic crisis is a condition caused by very high levels of circulating thyroid hormone. It is rare, but when it occurs after a thyroidectomy, it is usually associated with Graves' disease. Symptoms include fever (over 102 degrees Fahrenheit in most people), profuse sweating, heart palpitations, and sometimes delirium .

Using iodine was thought to reduce risk, but a 2017 study questioned the benefits. Treatment (in the intensive care unit) includes refrigeration, IV fluids, medications such as propylthiouracil, and treatment for arrhythmias.

Risks of anesthesia

Possible complications from general anesthesia can also occur, as most thyroidectomies require.

Risk factor's

While complications can affect anyone, there are some risk factors that increase the likelihood of side effects. These include:

  • Be over 70 years old
  • Of smoking
  • The presence of other medical conditions, such as congestive heart failure or bleeding disorders.
  • Thyroid cancer, especially when a central neck dissection is done to remove the lymph nodes.
  • Reoperation of the thyroid gland.

Although total thyroidectomy is more extensive than subtotal thyroidectomy, several studies, including a 2016 review , suggest that the safety of the two procedures is similar in terms of complications, although transient low calcium levels (and hypothyroidism due to removal of whole thyroid gland) are more common and are found in the general procedure.

Inpatient versus outpatient treatment

There has been some controversy about inpatient thyroidectomy versus outpatient thyroidectomy , especially with the recent trend toward same-day surgery. The main cause for concern is that life-threatening bleeding (bruising to the neck) can occur after a person has returned home from outpatient surgery. In terms of safety, a 2018 study suggests that outpatient surgery may be safe, but the researchers acknowledged that the study may be biased – people with higher risk are more likely to be hospitalized, while those with lower risk are more likely. more likely to be hospitalized). offer the procedure on an outpatient basis).

The scope and expertise of healthcare providers

Also keep in mind that the chance of a complication is much less with an experienced surgeon. With that in mind, it is a good idea to ask your surgeon how many thyroidectomies he has performed in the past. You can also ask about the frequency of complications, but this is not necessarily an accurate indicator of competence (more experienced surgeons may agree to accept more complex cases, which are likely to have a higher complication rate, and less experienced surgeons may limit themselves). to cases.) low risk).

Recovery

After surgery, you will be monitored in a recovery room, sometimes for up to six hours. During this time, the staff will monitor you closely for any signs of neck swelling that may indicate a neck bruise.

You can stay in the hospital overnight or you will be allowed to go home if you have had outpatient surgery and are stable. The head of the bed will be raised to reduce swelling and you will be allowed to continue your normal diet. If you have a sore throat or pain when swallowing, a soft diet will be more comfortable.

Before leaving the hospital, the nurse will review all instructions and discuss when to see your surgeon. Make sure you know what your home treatment regimen involves (medications, supplements) and how to take prescription pain relievers, if applicable. Be aware that pain relievers can cause constipation, and your healthcare professional may recommend a stool softener and / or laxative.

Limitations and recovery time

Most people are advised to take a two-week vacation to recuperate, depending on their occupation. You should not drive while you still need pain relievers, and some surgeons recommend that you refrain from driving entirely for the first week after surgery.

You should also avoid lifting heavy or strenuous activities (like many sports) for several weeks. Excessive activity can increase your chances of developing a bruise or interfere with proper wound healing. Light cleaning and walking is fine when you get home.

Incision care

The surgeon will discuss with you whether you should continue wearing the incision dressing. Depending on the surgeon, you may have stitches that need to be removed or absorbable sutures that will not need to be removed. If sterile strips have been applied, they usually stay in place for about a week. Most surgeons recommend leaving them alone until they fall off on their own, rather than trying to remove them.

You can probably shower, but try to keep your neck as dry as possible. You should not soak, soak, or rub your incision, and you should also avoid bathing in the tub before visiting the surgeon. After showering, you can lightly wet your neck or use a hair dryer to cool down.

The incision may appear red and hard at first, and you may notice slight swelling and bruising around the scar. If you experience itchiness, applying scar gel or aloe vera may soothe it, but check with your surgeon first. The hardening usually peaks around three weeks after surgery and then disappears within the next two to three months.

Over time, your incision will turn pink and then white, and most will heal completely in six to nine months.

Because the area around your incision will be prone to sunburn, wear sunscreen every time you go outside for at least a year after surgery. If you're wondering what your scar would look like, the University of California, Los Angeles has a scar gallery with images of people who have undergone thyroid surgery at different stages of the healing process.

Follow up

Generally speaking, you will usually need to return to the surgeon for a follow-up visit about a week or two after surgery. In the meantime, be sure to contact your thyroid care team if you have any questions about the recovery process.

At your follow-up appointment, your surgeon will determine if you need to continue taking calcium and vitamin D if prescribed. If you have started hormone replacement therapy, you should have a TSH test about six weeks after surgery.

Thyroid Discussion Guide for Healthcare Professionals

Get our printable guide to your next doctor's appointment to help you ask the right questions.

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Knowing what to expect before thyroid surgery can help you cope with possible side effects, reduce complications, and make your recovery easier. As with any surgery, it is normal for questions, concerns, and perhaps even minor concerns to come up. Discuss what you have in mind with your doctor. Keep in mind that even when complications do occur, which are rare, prompt treatment can often return your health to normal.

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