Post Operative Instructions | Endocrine Surgery
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After your operation

The information below applies to most surgical procedures.
Dr. Miller will give you more instructions about your specific procedure.

What happens after the operation?

After surgery, you will be encouraged to walk and stay active. Walking reduces the risk of complications like blood clots and pneumonia.

Pain Control

Discomfort, swelling, and some bruising in the week or two after an operation is expected. You should take panadol and/or nurofen regularly for pain. For the first week or two (depending on your operation) you may need something stronger in addition. A prescription for narcotic pain medication will be provided. Beware that narcotic pain medicine can make you drowsy and constipated. If affected, you should not drive or operate machinery. You should eat lots of fruits and vegetables, drink plenty of water, and consider Metamucil or stool softeners to prevent constipation while on narcotic pain medicine.

Care of your Incision

Your incision is covered with a waterproof protective dressing. You can shower as usual, but do not soak or scrub the dressing. After showering, pat dry. Often there will be a “blood blister” visible under the clear dressing. This is normal and no cause for alarm. Your dressing will be removed at your first post-operative visit. Most patients have sutures under the skin that dissolve by themselves. If you experience itching once the dressing is off, massage lotion into the scar. You might notice bruising around your incision. Your scar may become pink and hard. This hardening will peak at about 3 weeks, and will disappear over the next 3 to 4 months. You will also notice some numbness around the incision. This will gradually improve over time. You scar will continue to fade for 12 months. For best cosmetic results, keep it out of the sun.

What can I do after surgery?

You may shower the day after surgery. You can eat and drink whatever you like. You can walk, climb stairs, and do light activity without delay. Activities such as jogging, tennis, and sexual activity can be resumed when your body feels comfortable doing them. You should not drive or operate machinery as long as you need prescription pain medicine. You will receive specific instructions for return to heavier activity and work.

Call your doctor for:

  • Temperature over 38.3 C

  • Increasing pain, swelling, or redness of the incision, or foul-smelling discharge

  • Chest pain or difficulty breathing (or call an ambulance if severe)

  • If you are worried about any aspect of your recovery

Post-Operative Instructions for Thyroid Surgery

  • Questions: call the office on 9347 8786
  • After hours emergency: Dr Miller's mobile - emergency only please

Below are general instructions for patients who have had thyroid or parathyroid surgery. Since individual circumstances may vary, it is important that you discuss your individual post operative care with us.

Monitoring Your Progress

You should feel improvement every day after surgery. If you have any questions regarding your progress, call my office. You should make a follow up appointment approximately 1-2 weeks after your surgery.

Incision

Your incision is covered with a waterproof protective dressing. You can shower and wash your hair as usual, but do not soak or scrub the dressing. After showering, pat dry. Your dressing will be removed at your first postoperative visit. If you experience itching once the dressing is off, you may apply lotion to the scar. I recommend keeping Micropore tape on the scar (available at any pharmacy) for about 6 weeks. It will help the scar fade more quickly. Change it every few days. You might notice bruising around your incision or upper chest and slight swelling behind the scar when you are upright. In addition, the scar may become pink and hard. This hardening will peak at about 3 weeks and may result in some tightness or difficulty swallowing, which will disappear over the next 3 to 4 months. You will also notice some numbness of the skin of your neck. This will gradually improve over time.

Pain

The main complaint following thyroid surgery is discomfort with swallowing. Some people experience a dull ache, while others feel a sharp pain. This should not keep you from eating anything you want, but the pain can be annoying for a few days. Nurofen and/ or Panadol is generally enough to control this pain. Some people prefer Panadeine, but in general, stronger medications are not necessary for long. You may feel like you have phlegm in your throat. This is usually because there was a tube in your windpipe while you were asleep that caused irritation that you perceive as phlegm. You will notice that if you cough, very little phlegm will come up. This should clear up in 4 to 5 days.

Thyroid Hormone Tablets

If your whole thyroid was removed, you will be prescribed thyroid hormone tablets following surgery. Six weeks after the operation, you will have a blood test to measure your levels of thyroid hormone and your dose of medication may be adjusted accordingly. Your thyroid hormone levels will then be measured about every 2 months until your hormone levels are stable (levels generally stabilise within 4 to 5 months).

Voice Changes

Your voice may go through some temporary changes with fluctuations in volume and clarity (hoarseness). Temporary changes are quite common. Generally, it will be better in the mornings and "tire" toward the end of the day. This can last for variable periods of time, but should clear in 4-6 months at most. There is a small (1/100) risk of permanent hoarseness. There is a higher chance your singing voice will be affected.

Hypocalcaemia after total thyroidectomy – tingling and numbness of fingers and toes

In about 10% of patients who have a total thyroidectomy, the parathyroid glands do not function properly immediately. This is usually temporary and causes the blood calcium level to drop below normal (hypocalcaemia). Symptoms of hypocalcaemia include numbness and tingling in your hands, soles of your feet and around your lips, and can become quite unpleasant. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours. Low blood calcium does not occur if only half the thyroid is removed.

Hypocalcaemia is treated with calcium tablets. If you are having a total thyroidectomy, I recommend you purchase Calcium (Caltrate Plus) tablets before surgery so you have them at home if you need them. If you feel you need it, take the two tablets (there is no danger in taking it, even if you do not need it) The symptoms of tingling/numbness should improve within 30-45 minutes of taking the tablets. If the symptoms persist, you should take two more tablets and wait another 45 minutes. If they still persist after 3 extra doses, call my office in working hours, or after hours report to your nearest emergency room to have your blood calcium checked. Some patients also need vitamin D tablets to assist with absorption of the calcium.

Once you start taking the calcium, you should repeat the dose whenever the symptoms return. This may mean that you are taking as many as 2 tablets every 3 hours. Please keep us informed, and keep a record of the amount required. The hypocalcaemia usually disappears over a few weeks to months. In some cases (about 2-4% of all total thyroid operations), the parathyroid glands do not recover. If that happens, you will need to continue taking calcium tablets permanently, but typically not as many tablets as you needed in the first few weeks.

Bone Health

Patients who are taking thyroid hormone tablets or who have a history of parathyroid disease should consider taking Caltrate Plus twice daily to promote healthy bones. In addition, an exercise routine using weights is also recommended.

CONTACT MY OFFICE for any of the following symptoms:

• Fever >38.3 or chills
• Increasing pain or redness around incision
• Difficulty breathing
• Tingling around the lips or fingertips not relieved by extra calcium tablets
• Severe muscle cramps

AN IMPORTANT WORD ABOUT THE COSTS OF TREATMENT

Insurance rebates have not kept pace with the cost of running a medical practice. As a consequence, there will be a gap to pay for the surgical fee and for the anaesthetist. Your insurance company might also charge you an excess for a hospital admission. We will advise you about expected out-of-pocket costs not covered by insurance. If these costs represent an undue hardship for you, please discuss them with us.

ASK YOUR DOCTOR

We are here to help you. If you have any questions, please ask. It is often helpful to bring a family member with you to a consultation, or to write questions down so you won’t forget them.


Post-Operative Instructions for Parathyroid Surgery

  • Questions: call the office on 9347 8786
  • After hours emergency: Dr Miller's mobile - emergency only please

Below are general instructions for patients who have had thyroid or parathyroid surgery. Since individual circumstances may vary, it is important that you discuss your individual post operative care with us.

Monitoring Your Progress

You should feel improvement every day after surgery. If you have any questions regarding your progress, call our office. You should make a follow up appointment approximately 1-2 weeks after your surgery.

Incision

Your incision is covered with a waterproof protective dressing. You can shower and wash your hair as usual, but do not soak or scrub the dressing. After showering, pat dry. Your dressing will be removed at your first postoperative visit. If you experience itching once the dressing is off, you may apply lotion to the scar. I recommend keeping Micropore tape on the scar (available at any pharmacy) for about 6 weeks. It will help the scar fade more quickly. Change it every few days. You might notice bruising around your incision or upper chest and slight swelling behind the scar when you are upright. In addition, the scar may become pink and hard. This hardening will peak at about 3 weeks and may result in some tightness or difficulty swallowing, which will disappear over the next 3 to 4 months. You will also notice some numbness of the skin of your neck. This will gradually improve over time.

Pain

The main complaint following parathyroid surgery is discomfort with swallowing. Some people experience a dull ache, while others feel a sharp pain. This should not keep you from eating anything you want, but the pain can be annoying for a day or two. Nurofen and/ or Panadol is generally enough to control this pain. Some people prefer Panadeine, but in general, stronger medications are not necessary for long. You may feel like you have phlegm in your throat. This is usually because there was a tube in your windpipe while you were asleep that caused irritation that you perceive as phlegm. You will notice that if you cough, very little phlegm will come up. This should clear up in 4 to 5 days.

Voice Changes

Your voice may go through some temporary changes with fluctuations in volume and clarity (hoarseness). Temporary changes are quite common. Generally, it will be better in the mornings and "tire" toward the end of the day. This can last for variable periods of time, but should clear in 4-6 months at most. There is a small (1/100) risk of permanent hoarseness. There is a higher chance your singing voice will be affected.

Hypocalcemia and Bone Health

Your bones have been starved of calcium during the time you have had hyperparathyroidism, and will now have the chance to grow strong again. After successful parathyroid surgery, I recommend you take Caltrate Plus twice a day (available at any chemist) to promote healthy bones. In addition to these supplements, an exercise routine using weights is also recommended.

In a small number of patients who have parathyroid surgery, the remaining parathyroid glands have become lazy, and do not function properly immediately after surgery. It is very rare after the mini-surgery, but about 10% if you need both sides of the neck explored. This is usually temporary and causes the blood calcium level to drop below normal (hypocalcaemia). Symptoms of hypocalcaemia include numbness and tingling in your hands, soles of your feet and around your lips. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours.

Hypocalcaemia is treated with extra calcium tablets. You should purchase Calcium (Caltrate) tablets before surgery so you have them at home. If you feel you need it, take two extra tablets (there is no danger in taking it, even if you do not need it.) The symptoms of tingling/numbness should improve within 30-45 minutes of taking the tablets. If they do not disappear, take two more, and repeat as necessary each 30-45 minutes. If the symptoms do not disappear after 3 doses, call my office in business hours, or after hours report to your nearest hospital emergency room to have your blood calcium checked, and let my office know about it. Some patients also need a tablet called calcitriol to help absorb calcium from your diet.

You should repeat the dose whenever the symptoms return. This may mean that you are taking as many as 2 tablets every 3 hours. It is important that you keep us informed. The hypocalcaemia should disappear over a few weeks. Keep a record and let us know at your post-surgery visit if you are needing extra calcium.

CONTACT MY OFFICE for any of the following symptoms:

  • Fever >38.3 or chills
  • Increasing pain or redness around incision
  • Difficulty breathing
  • Tingling around the lips or fingertips not relieved by calcium tablets
  • Severe muscle cramps

AN IMPORTANT WORD ABOUT THE COSTS OF TREATMENT

Insurance rebates have not kept pace with the cost of running a medical practice. As a consequence, there will be a gap to pay for the surgical fee and for the anaesthetist. Your insurance company might also charge you an excess for a hospital admission. We will advise you about expected out-of pocket costs not covered by insurance. If these costs represent an undue hardship for you, please discuss them with us.

ASK YOUR DOCTOR

We are here to help you. If you have any questions, please ask. It is often helpful to bring a family member with you to a consultation, or to write questions down so you won’t forget them.


Post-Operative Instructions for Adrenal Surgery

Questions: call the office on 9347 8786
After hours emergency: Dr Miller's mobile - emergency only please

Below are general instructions for patients who have had adrenal surgery. Since individual circumstances may vary, it is important that you discuss your individual post operative care with us.

Monitoring Your Progress

You should feel improvement every day after surgery. If you have any questions regarding your progress, call my office. You should make a follow up appointment approximately 1-2 weeks after your surgery.

Incision

Your incision is covered with a waterproof protective dressing. You can shower as usual, but do not soak or scrub the dressing. After showering, pat dry. Your dressing will be removed at your first post-operative visit. If you experience itching once the dressing is off, you may apply lotion to the scar. You might notice bruising around your incision. In addition, the scar may become pink and hard. This hardening is temporary and will last some weeks. You may also notice some numbness around the incision. This will gradually improve over time.

Pain

The main complaint following minimally invasive adrenal surgery is minor wound discomfort. Some people experience a dull ache, while others feel a sharp pain. This should not keep you from light activity. Nurofen and/ or Panadol is generally enough to control this pain. In general, stronger medications are not necessary for long.

CONTACT MY OFFICE for any of the following symptoms:

  • Persistent fever >38.5 or chills
  • Persistent nausea or vomiting, unable to keep liquids down
  • Increasing pain or redness around incision
  • Persistent cough, shortness of breath, or difficulty breathing
  • Fainting or increased abdominal swelling

AN IMPORTANT WORD ABOUT THE COSTS OF TREATMENT

Insurance rebates have not kept pace with the cost of running a medical practice. As a consequence, there will be a gap to pay for the surgical fee and for the anaesthetist. Your insurance company might also charge you an excess for a hospital admission. We will advise you about expected out-of pocket costs not covered by insurance. If these costs represent an undue hardship for you, please discuss them with us.

ASK YOUR DOCTOR

We are here to help you. If you have any questions, please ask. It is often helpful to bring a family member with you to a consultation, or to write questions down so you won’t forget them.

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Dr. Julie Miller - Specialist Endocrine Surgeon
Dr. Julie Miller - Specialist Endocrine Surgeon
 

© Dr. Julie Miller Endocrine Surgeon Thyroid Parathyroid Adrenal Melbourne Australia

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