What to Expect Before and After a Thyroidectomy
Average Read Time: 5 minutes
Thyroid surgery — known as a thyroidectomy — removes all or part of your thyroid gland. A thyroidectomy is done to treat a number of thyroid conditions:
Thyroid cancer: Many types of thyroid cancer are treated with thyroidectomy. (The only exception is for very small, non-aggressive papillary thyroid cancer, known as a microcarcinoma. Some doctors now recommend “watchful waiting” and periodic monitoring for those cancers.)
Goiter: If you have an enlarged thyroid (called a goiter) your doctor may recommend surgery if the goiter is large and cosmetically unsightly, or if it affects your ability to breathe or swallow.
Thyroid nodules: Thyroidectomy is often recommended for large, easily visible thyroid nodules. It’s also recommended for nodules that are “hot” or “toxic,” meaning that they are producing excess thyroid hormone and making you hyperthyroid, and for nodules that affect your ability to breathe or swallow.
Hyperthyroidism: Thyroidectomy is sometimes performed as a treatment for hyperthyroidism, particularly if you don’t respond to antithyroid drugs, are allergic or sensitive to them, and don’t want radioactive iodine (RAI) ablation treatment. In some cases, thyroidectomy is recommended for women in the second trimester of pregnancy who have not responded to antithyroid drugs or when the antithyroid drugs are affecting the mother and/or baby negatively. Also, surgery is sometimes offered to a woman of child-bearing age who does not want to wait the recommended six months to a year after RAI before getting pregnant.
Hashimoto’s Thyroiditis: While it’s less common, thyroidectomy is sometimes done as a treatment for Hashimoto’s. In 2019, the Annals of Internal Medicine (AIM) published research findings that reported that patients with chronic Hashimoto’s and very elevated antibodies significantly improved their quality of life, reduced symptoms, and cut antibodies by around 92% after thyroidectomy, compared to just taking medication.
UP NEXT: You’ve Been Diagnosed with Thyroid Cancer: What’s Next?
Types of Thyroid Surgery
There are many different types of thyroidectomy surgeries.
Total or full thyroidectomy: A total thyroidectomy (also called a full thyroidectomy) is the most frequently performed type of thyroid surgery. This surgery involves the removal of the entire thyroid gland, including both lobes and the isthmus.
Subtotal or partial thyroidectomy: A subtotal thyroidectomy (also known as a partial thyroidectomy, or near-total thyroidectomy)removes only part of the thyroid gland.
Isthmusectomy: When a small nodule or tumor is located in the isthmus between the lobes of the thyroid, an isthmusectomy (sometimes called an isthmectomy) may be performed.
Thyroid lobectomy: Also known as a hemi-thyroidectomy, this procedure involves removal of one lobe, or side, of the thyroid gland. A lobectomy can be performed with or out without an isthmusectomy.
According to the American Thyroid Association, your condition will dictate the extent of the thyroid surgery recommended for you.
Methods of Thyroid Surgery
Traditional thyroid surgery involves a 3- to 5-inch incision in the neck, which is then closed with sutures, staples, or both.
In endoscopic thyroid surgery, two small incisions — usually less than an inch in length — are made in the neck. A camera is inserted through one incision, and a scalpel is inserted through the second incision.
In an axillary thyroidectomy, the thyroid is accessed through the underarm. This surgery leaves a scar under the arm.
In scarless transoral thyroidectomy, the thyroid is removed via small incisions in your gumline, eliminating any scars. When robotic devices are used to assist the surgery, it’s called Transoral Robotic Thyroidectomy (TORT)
Robotic facelift thyroidectomy involves an incision behind your ears, in your hairline.
Thyroid surgery typically takes from 45 minutes to several hours, depending on the type and extent of the surgery. If you have thyroid cancer and are having lymph nodes removed — known as neck dissection — the surgery may require more time.
You will most often be admitted to the hospital and stay one to two nights after thyroidectomy. There is an increasing trend toward outpatient thyroid surgery, where you spend some time in recovery and are released, usually within 24 hours of your surgery. Outpatient thyroidectomy is controversial, however. Some studies show that outpatient surgery is as safe and effective as inpatient thyroidectomy. Other studies suggest that it poses greater risks, especially if you have post-surgical bleeding.
Make sure that you are fully informed in advance about the extent of surgery, and the type of surgery planned.
Before your surgery, you should ask your surgeon what preparations, if any, you need to make prior to the surgery. This includes when you should stop eating/drinking, and whether or not to take any prescription or over-the-counter medications and supplements before surgery.
You should also get your surgeon’s advice regarding your recuperation, when to return to work, how soon you can drive, exercise, and return to normal activity. In addition, you should get some guidance on how to care for your scar after surgery.
You will most likely be hypothyroid and require lifelong prescription thyroid hormone replacement medication after surgery. Before your surgery, you should discuss with your physicians the plan for when to start your medication, which medication will be prescribed, and a plan for periodic blood testing and monitoring to ensure that you are getting the optimal dose of medication.
Types of Anesthesia
Because the thyroid is adjacent to your windpipe, most thyroid surgery is performed while you are under a general anesthetic, with a breathing tube inserted to help you breathe. In a small percentage of cases, you may have the option to have your surgery using local anesthesia. In that case, you would be given a sedating medication, along with a numbing medication, followed by local anesthesia. Few surgeons are trained in doing thyroidectomy with local anesthesia. If you choose this option, you need to be sure your surgeon has performed a substantial number of thyroid surgeries using local anesthesia.
Potential Complications After Thyroid Surgery
Normal side effects after thyroidectomy include some pain and stiffness in the neck, and a sore throat, usually treatable with over-the-counter pain medication. Temporary impairment of your parathyroid glands can cause low calcium levels, which can cause tingling and numbness in your mouth, lips, and extremities. This is treated with calcium and vitamin D supplements.
More significant, but far less common, risks include:
- Post-surgical bleeding
- Damage to your laryngeal nerve, which controls your vocal cords. You can have a weak and/or hoarse voice, which usually resolves on its own. A small percentage of patients have permanent hoarseness.
- Hypoparathyroidism/hypocalcemia: The parathyroid glands can be injured, or sometimes need to be removed, during surgery. These glands control your body’s calcium levels. Hypocalcemia causes numbness and tingling in the fingers and mouth, as well as muscle cramps. Around 5% of patients have temporary hypocalcemia — low calcium levels — after thyroidectomy, and 1% have permanent hypocalcemia. In both cases, the treatment is calcium and vitamin D supplementation.
Complications are more common if you have invasive thyroid tumors, advanced disease, extensive involvement of your lymph nodes, or are having a repeat thyroid surgery.
The risks of significant complications are also directly correlated to the experience of your surgeon.
Choosing a Surgeon
While thyroid surgery is often performed by general surgeons and head/neck surgeons, you will likely have the best outcome and a significantly lower risk of complications if you work with an experienced or expert thyroid surgeon.
The New York Thyroid Center at Columbia University Medical Center recommends you choose a surgeon who performs at least 50 thyroidectomies a year, and who has done at least 500 thyroidectomies in his or her career.
If your surgeon is recommending a newer technique such as axillary, transoral, or endoscopic thyroid surgery, you should ask about their experience with these types of surgeries.
Also, be sure to ask your prospective surgeon about their complication rates, as well as the rates at the hospital or surgery center. Choosing an experienced surgeon with a low complication rate, and a hospital/surgery center with a low complication rate will all help you greatly lower your own risk of complications.
Life After Thyroid Surgery
As mentioned, after surgery, you are almost always going to face hypothyroidism. If your surgery was for an overactive thyroid, it may take several weeks for the excess thyroid hormone in your system to drop. If your surgery is for cancer, goiter, nodules, or Hashimoto’s, you are likely to become hypothyroid almost immediately.
Here are a few pointers for a healthier life after thyroid surgery.
Have a Plan in Place
It is important to have a plan in place before your surgery for post-surgery thyroid hormone replacement. And just as importantly, you will want to have a healthcare provider already in place and available to you for your post-surgery thyroid management.
Don’t assume that your surgeon will be available, or even helpful. You don’t want to get caught in a situation like thyroid patient and advocate Tara Flotta did after her thyroidectomy. She described her experience for my Thyroid Deep Dive podcast:
Upon discharge, the surgeon prescribed me a total of 25 micrograms of Synthroid. For people who aren’t familiar with the dosages, for full replacement of a missing thyroid, 25 micrograms aren’t even going to make a dent in it. To give a comparison, today I take 125 micrograms of levothyroxine plus 15 micrograms of a T3 compounded medication. So, this was a fraction of what I eventually ended up needing. About a week after my surgery, I was feeling weak, frail, and had some heart palpitations. I knew on the discharge papers it said, if you have any of these symptoms, call the surgeon. I had an appointment on the books with an endocrinologist, but I was considered a new patient to the practice. So, when I called saying, “I don’t feel well”, they said, “You’re still considered a new patient, so we can’t advise you. You need to go to the surgeon.” I called the surgeon and I will share with you what he said, because I know this is part of what we’re all trying to accomplish here with thyroid advocacy. When he picked up the phone, he said to me, “Is this attention-seeking behavior, or is something actually wrong?
– Tara Flotta
Tara had become seriously hypothyroid post-surgery, and needed a dosage increase in her thyroid medication, but was caught between an unsympathetic surgeon and an endocrinologist’s office that refused to help. She ended up in the emergency room for a few days. Thanks to a more knowledgeable staff endocrinologist, she was able to get an immediate increase in her dosage of thyroid medication.
You May Need Supplemental T3
The two key hormones the thyroid gland produces are T4 and T3. T4 needs to be converted into T3 (the active thyroid hormone) to be usable by the body. That conversion typically takes place in the thyroid gland and some other tissues. The thyroid also produces a small amount of T3 as well. After thyroid surgery, you no longer have a thyroid to produce T3. AND, you no longer have a thyroid as a key place for the T4 to convert into T3.
As a result, many patients find that after thyroidectomy, they benefit from combination T4/T3 treatment, whether adding synthetic T3 to levothyroxine or taking a natural desiccated thyroid drug. Make sure that you and your doctor are on the same page about this from the start. This will help ensure that your doctor quickly and accurately offers the right post-surgery treatment that will help you get back to good health and thyroid balance.
Be Knowledgeable and Empowered
It’s going to be more important than ever after surgery to understand the key thyroid tests — like thyroid stimulating hormone (TSH), free thyroxine (Free T4), and free triiodothyronine (Free T3) — AND to understand what your test results mean.
You’ll also want to make sure that you know the difference between the “reference range” and the “optimal range” — the thyroid levels where patients usually feel best.
You should become familiar with your various thyroid hormone replacement options, including levothyroxine tablets (brand names like Synthroid, Levoxyl, Unithroid, and Euthyrox, and generic tablets), Tirosint liquid levothyroxine gel capsules, Tirosint-SOL levothyroxine solution, synthetic T3 (liothyronine) like Cytomel, and natural desiccated thyroid drugs like Nature-throid, WP Thyroid, Armour Thyroid and NP Thyroid.
Take Care of ALL of You
Remember that after thyroidectomy, thyroid hormone replacement can often only do so much. To truly feel and live well, you may need to incorporate better nutrition, stress reduction, self-care, and other lifestyle changes into your daily routine.