Side Effects and Complications of Thyroid Surgery

A Look at Post-Thyroidectomy Complications

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Thyroid surgery is considered extremely safe. Some of the more common side effects—for example, pain when swallowing, and neck stiffness—are discussed in greater depth in the article on Recuperating After Thyroid Surgery.

The risk of more significant complications is higher for total thyroidectomy as compared to subtotal thyroidectomy. Complications are also more likely with surgeons who have less experience performing thyroid surgery, so it's important to make sure that you have an experienced thyroid surgeon.

Find out more in the article about Choosing a Top Thyroid Surgeon.

Hypoparathyroidism and Hypocalcemia

Hypoparathyroidism is under functioning of the parathyroid glands. The function of the parathyroids is to control your body's calcium levels. If the parathyroids are damaged or nicked during surgery, this trauma can cause temporary or permanent shutdown, which results in a lowered calcium level, called hypocalcemia.

Permanent hypoparathyroidism is rare, but transient hypoparathyroidism affects approximately 7 percent of patients. Some patients are, however, at a higher risk of hypoparathyroidism and hypocalcemia. The risk factors include:

  • surgery for hyperthyroidism or Graves' disease
  • surgery for multinodular goiter
  • full thyroidectomy, rather than a lobectomy
  • central neck dissection for thyroid cancer, which involves removing lymph nodes and lymph tissue around the thyroid
  • a repeat thyroid surgery

    Discuss your risk factors for hypoparathyroidism with your surgeon, and be sure to mention any potential symptoms you experience. Symptoms, which usually appear the first week after surgery, can include:

    • numbness and tingling feeling around your lips, hands, and the bottom of your feet
    • crawly feeling in your skin
    • muscle cramps and spasms
    • bad headaches
    • anxiety
    • depression

    These symptoms usually start in the day or two after surgery. It is rare for these symptoms to appear after 72 hours.

    Your doctor will typically recommend temporary calcium supplementation. Ask your doctor if you should have calcium tablets on hand before the surgery, and how you should proceed if you have symptoms.

    If you take calcium for hypocalcemia symptoms, tingling and numbness usually go away within a half-hour after taking calcium. While practitioners usually recommend that you take calcium as often as needed to control your symptoms, be sure to discuss this with your doctor beforehand.

    The hypocalcemia should disappear in 7 to 10 days. If it doesn't, tell your physician. If you are one of the few patients who develop permanent hypoparathyroidism, the treatment is calcium and vitamin D, for life.

    If the parathyroid glands cannot be preserved during a total thyroidectomy, some surgeons will cut the glands into small pieces and then inject them into a muscle – the shoulder, for example – where the gland piece can function to regulate the body's calcium level.

    Laryngeal Nerve Damage

    In an estimated 1 out of every 250 thyroid surgeries, the damage is done to the laryngeal nerves, the nerves that control the voice.

    The primary symptoms include:

    • Difficulty projecting the voice
    • Hoarse voice
    • Voice fatigue
    • Decreased vocal range

    Usually, voice changes are temporary, so the voice will return to normal within a few weeks; permanent changes are rare. Use of nerve monitors during surgery has become more common, however, as these surgical devices can greatly reduce the risk of damage. 


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