When you have hypothyroidism, your thyroid gland doesn’t produce enough hormone. The most common cause of hypothyroidism is Hashimoto’s thyroiditis. In this condition, the body’s immune system mistakes the thyroid gland for something it needs to attack. Hypothyroidism may also occur if there’s not enough iodine available for the thyroid to make hormone, if there are problems with the pituitary gland, or if the thyroid gland is removed.
With hyperthyroidism, the thyroid gland produces too much hormone. The most common cause of hyperthyroidism is Graves’ disease, a problem where the body’s immune system overstimulates the thyroid. Graves’ disease sometimes causes the eyes to look like they’re bulging (exophthalmos). A nodule in your thyroid gland can cause hyperthyroidism if the cells in the nodule produce more hormone than the rest of the gland.
Nodules are lumps of tissue in the thyroid gland. Usually, the cause of nodules isn’t known, but they may be more common in people who’ve had therapeutic radiation to the head or neck. Most of the time, nodules don’t affect the production of thyroid hormone and cause no symptoms. Sometimes they can be felt on the outside. Most nodules are benign (noncancerous), but occasionally a nodule may be cancerous.
Surgery can be done to remove a very large goiter or nodule, a hyperthyroid gland that can’t be controlled with medications, or a thyroid gland that may be cancerous.
Ask your surgeon whether you need to stop taking aspirin, other medications, supplements, or herbal remedies before your procedure. Unless instructed otherwise, don’t eat anything for 12 hours before the procedure. You may take clear liquids up until 4 hours before the procedure. You’ll probably be admitted to the hospital or surgery center on the day of surgery. You usually need to be monitored after surgery, so prepare to spend one or more days in the hospital.
During the procedure, an intravenous (IV) line provides you with fluids and medications. You’ll be given general anesthesia, so you’ll be asleep during the procedure. An incision is made in your neck, along a crease in your skin. The surgeon may remove one half of the thyroid gland (lobectomy), most of the gland (subtotal thyroidectomy), or the entire gland (total thyroidectomy). Sometimes, the decision about how much of the thyroid to remove can’t be made until the surgeon makes the incision and can see the area around the thyroid. Once the procedure is completed, the incision is closed with surgical strips, glue, or sutures. Occasionally, a drain may be left in the incision to remove fluid that can build up.
You can usually begin to eat and drink normally the evening after the procedure, but you may still be a little queasy from the anesthesia. Once the anesthesia has worn off and you’re feeling up to it, you’ll be able to get up and walk around. You may be given oral medication for pain the first day or so, but discomfort is usually minimal. A sore throat and hoarseness are common and may last for a week or so after surgery. During your hospital stay, you’ll be monitored for bleeding and to make sure your parathyroid glands are working normally. The stress of surgery may stun these glands for a short time, so you may be given calcium supplements for a few days.
You will be discharged the day after your surgery. You may be up and around as you desire, but should avoid overly strenuous activity for several days. You may walk and climb stairs. You may resume normal activities after the first week. You may drive once you are off pain medication and are able to move and turn your neck easily.
The original dressing will usually be removed before you are discharged. Leave the white steri-strips on the incision until your follow up visit. The steristrips may get wet. Surgical glue can get wet the day after surgery as well. Bruising or puffiness is normal; spreading redness is not.
For the first 24 hours after surgery, you may not have much of an appetite or feel able to tolerate heavy foods. We encourage you to begin with a soft diet and to keep up with your liquids. As your appetite increases, and you are not having difficulty swallowing, you will find yourself eating normally. There are no restrictions- just eat what your system can tolerate.
You may be given a prescription for pain medication Prescription pain
medications are there to help you recover comfortably, but stop them as soon as you are able.
Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above all constipation, are
common. If you have these issues, try to use ibuprofen and Tylenol instead (see below). Do not
use alcohol or drive if you are taking prescription pain medications.
Unless you are told differently by your surgeon or primary doctor, you can take 400 mg ibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for a maximum dose of about 2400 mg/day (refer to the label for specific dosing based on age and weight). It is best if you can take some food with this medication.
Tylenol is also acceptable to help with the baseline pain after surgery. It can be taken in conjunction with ibuprofen, and with your prescription (unless your prescription already contains acetaminophen--which is Tylenol). Be very careful not to exceed the dosage on the bottle. Taking more than 3 grams/day is not advisable.
Blood thinners should only be restarted after surgery according to the plan discussed with you by your surgeon or prescribing doctor before surgery. If this was not made clear to you, call our office.
All other medications should be resumed once you get home. We would suggest sleep aids not be used while you are on narcotic pain medications.
You may be given a prescription for or asked to take calcium. Please follow your instructions carefully; your calcium levels may be monitored, depending on the extent of your surgery. If you are not given a prescription for Calcium, please purchase Tums to have available at your home for you to take if necessary. Two TUMS with each meal (6 per day) is recommended.
Constipation is very common after surgery. We recommend staying well hydrated, and using Miralax, prune juice, or Milk of Magnesia for a few days until things are back to normal. If you are at all prone to constipation, or if you need several days of pain medicine, it may help to add Benefiber, Metamucil or similar bulk fiber agents for a few days as well. Do not let more than 48 hours go by without a bowel movement without starting the above medications. If they fail to help within another 24 hours, call our office.
You may notice some swelling or slight drainage (usually pink or reddish in color) or bruising around the incision. This is normal and not cause for concern. However, please call our office immediately if you develop any of the following: difficulty breathing, tingling in your hands or face, difficulty speaking, difficulty swallowing, excessive drainage or bruising, redness or swelling around the incision, fever over 100F, or persistent nausea or vomiting.
You may need your calcium level measured. If so instructed, please have this test
done through your Primary Care Physician’s office, or at a lab specified by your insurance
company. The test results should be faxed to us immediately at (703) 591-6105.
You will be seen in our office 7 to 10 days after your surgery. Prior to surgery, you should have made an appointment for your first post-operative visit. If for some reason that appointment was not scheduled, please call our office at (703) 359-8640 as soon as your return home to schedule your appointment.
Please call us if any problems or questions arise. We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640.
After you’re feeling better, the right care can keep you feeling good. If you’ve been given thyroid hormone or other medications, take your pills regularly to help keep your thyroid hormone at the right levels and your body running smoothly. See your doctor as directed for regular blood tests. These tests confirm that your hormone pills or medications are still at a dose that’s right for you. If you’ve had treatment for cancer, regular exams help catch it early if it returns. No matter what the cause, thyroid problems don’t have to keep you from feeling good and doing what you like.