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Total Thyroidectomy

AMBULATORY CARE:

What you need to know about a total thyroidectomy:

A total thyroidectomy is surgery to remove all of your thyroid gland. Your thyroid gland makes hormones that control your metabolism, body temperature, and heart rate. Your thyroid gland is shaped like a butterfly. It is found in the front lower part of your neck. You may need a thyroidectomy if you have thyroid cancer or a growth on your thyroid. A growth that is not cancer can still become large enough to cause breathing problems. You may also need this surgery if you have hyperthyroidism. This means your thyroid creates too much thyroid hormone. You may have a sore throat, hoarse voice, or difficulty swallowing after surgery. It is normal to have these problems for up to 6 months after a total thyroidectomy.

How to prepare for a total thyroidectomy:

  • Your healthcare provider will tell you how to prepare for surgery. You may be told not to eat or drink anything after midnight on the day of surgery. Your provider will tell you which medicines to take or not take on the day of surgery. Blood tests are used to check the amounts of calcium and thyroid hormone in your blood. You may be given antithyroid medicine to lower the amount of thyroid hormone made by your thyroid gland.
  • You and your surgeon will decide the kind of surgery that is right for you. A thyroidectomy can be done in several ways. Your surgeon may make an incision in your lower neck. This is called a conventional thyroidectomy. An endoscopic surgery means small incisions are made in your neck. Tools and a small camera are put into the incisions. The camera helps your surgeon find the right area for surgery. A robotic surgery means incisions are made in your chest and armpit, or higher in your neck. Endoscopic and robotic surgeries leave smaller scars that are less visible.
  • An ultrasound may be used to check your thyroid and areas near the thyroid. This will help guide your surgeon during surgery.

  • A thyroid scan may show how well your thyroid is working. You may be given contrast liquid to help the pictures show up better. Tell a healthcare provider if you have ever had an allergic reaction to contrast liquid.
  • An MRI may be used to take pictures of your neck muscles, joints, bones, and blood vessels. You may be given contrast liquid to help the pictures show up better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
  • Laryngoscopy may be needed before and after your surgery. This test helps your healthcare provider know how well your larynx is working.

What will happen during a total thyroidectomy:

  • General anesthesia is usually given before a total thyroidectomy. This medicine will keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the area. You may feel some pressure during surgery, but you should not feel any pain.
  • After one or more incisions are made, your surgeon will remove your thyroid gland. If you have cancer, your surgeon may also remove the tissue and lymph nodes around your thyroid gland. If you are awake during surgery, you may be asked to speak to your healthcare providers.
  • One or more drains may be placed into your incision to remove extra fluids from the surgery area. Your incision will be closed with stitches or surgical glue and covered with a bandage.

What will happen after a total thyroidectomy:

Tell your healthcare providers if you have difficulty breathing or swallowing. Tell them if your bandage feels like it is getting tighter. You will have blood tests to check your calcium and thyroid hormone blood levels.

  • Thyroid hormone medicine will be given. You will need to continue taking this medicine to replace the hormone your thyroid would have produced. You may also be given pain medicine. Radioactive iodine may be given if your thyroid gland was removed because of cancer. This medicine may kill cancer cells that were not taken out during surgery.
  • Deep breathing helps open air passages and prevent a lung infection. Slowly take a deep breath and hold the breath as long as you can. Then let your breath out. Take 10 deep breaths in a row every hour while awake. You may be asked to use an incentive spirometer to help you with this. Put the plastic piece into your mouth and slowly take a breath as deep and as long as you can. Hold it as long as you can. Then let your breath out.

Risks of a total thyroidectomy:

You may bleed more than expected and need a blood transfusion. Your voice may be hoarse or weak after surgery, and this may become a long-term problem. Your neck may be bruised and swollen, and it may be hard for you to breathe or swallow. Your parathyroid glands may not work as well as they should after surgery. This can cause your calcium blood levels to drop too low. This may be a short-term problem after surgery, or it may be a long-term problem. You may get a blood clot in your arm or leg. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke.

Seek care immediately if:

  • You have sudden tingling or muscle cramps in your face, arm, or leg.
  • You have muscle spasms in your legs and feet that do not go away.
  • You have sudden abdominal pain.
  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  • Your incision comes apart, or blood soaks through your bandage.
  • You have sudden swelling in your neck or difficulty swallowing.
  • You suddenly feel lightheaded and short of breath.
  • You have chest pain when you take a deep breath or cough, or you cough up blood.

Contact your endocrinologist or surgeon if:

  • You have a fever.
  • You have pain in your surgery area that does not go away after you take pain medicine.
  • You lose weight, feel very nervous and hungry, and sweat for no reason.
  • You feel very tired and cold, gain weight for no reason, and your skin is very dry.
  • You vomit several times in a row.
  • Your skin is itchy, swollen, or has a rash.
  • Your incision is swollen, red, or has pus coming from it.
  • You have new voice weakness or hoarseness, or it is getting worse.
  • You have questions or concerns about your condition or care.

Medicines:

  • Thyroid hormone will replace the hormone your thyroid would have produced. You will need to take this medicine every day.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your endocrinologist or surgeon as directed:

You may need to return to have your bandage changed, drains removed, or more tests. Write down your questions so you remember to ask them during your visits.

Wound care:

Check the wound every day for signs of infection, such as redness, swelling, or pus. Carefully wash your skin near the incision wound area with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. You can use a mild body lotion to improve the scar.

Supplements:

Ask your endocrinologist if you need to take calcium or vitamin D and how much to take.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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