Post-Thyroidectomy Side Effects & Recuperation

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If you are having thyroid surgery, known as a thyroidectomy, it's important to know what to expect in terms of side effects, potential complications, and the recuperation process.

Right After Surgery

After your thyroid surgery, whether you remain in the hospital or are having outpatient surgery, you will typically spend several hours in the recovery room. For the first day, most doctors recommend you stay in bed.

Your doctor will, however, likely suggest that you begin moving about as soon as possible thereafter.

If you are hospitalized, you may remain on an intravenous drip for nutrition, as swallowing and eating can be difficult during the first 24 hours after surgery. If you are released, you may wish to try liquids or very soft foods until swallowing other foods is more comfortable.

Side Effects of Thyroidectomy

You may experience some short-term, less serious side effects after thyroid surgery. These can include:

  • Pain when swallowing, or in the neck area: Pain can come from the breathing tube after surgery or from the surgery itself. This should subside within a few days; an over-the-counter non-steroidal pain reliever, like ibuprofen, can relieve discomfort.
  • Neck tension and tenderness: Your tendency may be to hold your head stiffly in one position after surgery, and this can cause neck and muscle tension. It's good to do gentle stretching and range of motion exercises to prevent muscle stiffness in the neck area. Simply turning your head to the right, then rolling your chin across the chest until your head is facing left can help loosen tight muscles.
  • Voice problems: Your voice may be hoarse, whispery, or tired. Some people find that periods of hoarseness can last as long as two to three months.
  • Irritated windpipe: If you had a breathing tube during general anesthesia, it can irritate your windpipe and may make you feel as if you have something stuck in your throat. This feeling usually goes away within five days.

    Complications After Thyroid Surgery 

    Thyroid surgery is considered extremely safe. While complications are not common, there are several that can occur. These include hypoparathyroidism and hypocalcemia, and laryngeal nerve damage

    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
      • a 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 seven to 10 days. If it doesn't, tell your physician. If you are one of the few patients who develops 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—your shoulder, for example—where the gland piece can function to regulate the body's calcium level.

      Laryngeal Nerve Damage

      In an estimated one 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. 

      Recuperation Time After Thyroid Surgery

      Your doctor will likely recommend that you take one to two weeks to recuperate before you return to work and other normal activities. You should be able to return to driving and participating in other activities, as well as non-contact sports, as soon as you can turn your head normally and without pain or difficulty. Be sure that you clear this with your surgeon first, however.

      You will usually need to return to the surgeon for a follow-up visit around three weeks after surgery.

      Caring for Your Incision 

      While the coating applied over your incision will make it possible for you to bathe or shower after the surgery, you should not submerge, soak, or scrub your incision. After showering, you may want to use a hair dryer set to "cool" to dry the incision.

      The coating over your incision will usually turn white and peel off within a week. Once the coating falls off, you can start using a scar gel, aloe, vitamin E, or cocoa butter to help with healing and minimize itching. You might notice bruising or slight swelling around the scar. If you notice any significant swelling, you should contact your surgeon right away, as that could be a sign of infection. Over time, the scar may take on a pink color and feel hard. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months.

      Post-Surgery Thyroid Hormone Replacement  

      Patients receiving a total thyroidectomy—and the majority of patients receiving a subtotal thyroidectomy (partial removal of the gland)—find that their thyroid becomes unable to produce enough thyroid hormone, making them hypothyroid. When you are hypothyroid, you will need prescription thyroid replacement drugs. Your doctor may not discuss this with you, so be sure to have a conversation with him or her about when you will start thyroid medication, which medication, and at what dosage before you are discharged.

      If you are not immediately put on thyroid hormone medication, watch carefully for symptoms of hypothyroidism, and insist on full testing as soon as any symptoms appear. Symptoms of hypothyroidism include fatigue, sluggishness, depression, difficulty concentrating, memory problems, unexplained or excessive weight gain, dry skin, coarse and/or itchy skin, dry hair, hair loss, feeling cold (especially in the extremities), constipation, muscle cramps, joint pain, carpal tunnel syndrome, increased menstrual flow, low sex drive, and more frequent periods, among others. You'll find a detailed hypothyroidism symptoms checklist online. 

      A Word From Verywell

      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 expert thyroid surgeon. Some thyroid surgery authorities recommend choosing a surgeon who has performed at least 1,000 thyroid surgeries. 

      Sources:

      Benkhadoura M. "Recurrent laryngeal nerve injury and hypoparathyroidism rates in reoperative thyroid surgery." Turk J Surg. 2017 Mar 1;33(1):14-17. 

      Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 10th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2012.

      Erbil Yesim., et. al. "Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgeryClinical Otolaryngology 32 (1), 32-37.

      New York Thyroid Center. Columbia Department of Surgery - College of Physicians and Surgeons.

      Quaglino F, et. al. "When Is Thyroidectomy the Right Choice?" European Thyroid Journal. 2017 Apr;6(2):94-100. 

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