Frequently Asked Questions - Thyroid Surgery
What type of anaesthesia will I have?
You will have a general anaesthesia. You will be completely asleep during the operation. You will have local anaesthesia injected into the neck (cervical plexus block) to make you even more comfortable when you wake up. This local anaesthetic block will probably leave your ear lobes numb for 24 hours as well.
How much of my thyroid will be removed?
That depends on your condition and your doctor's advice. When the entire thyroid is removed, the operation is called a total thyroidectomy. You will need thyroid hormone replacement for life. A thyroid lobectomy or hemithyroidectomy is when half the thyroid is removed. In most instances (80%), the remaining half can make enough thyroid hormone and you will not need tablets.
How long will I be hospitalised?
Most patients are admitted to the hospital on the morning of their surgery and are able to go home the next day.
Will I have a scar?
Yes. All surgeries cause scarring, and how a patient scars is dependent on the individual. A thyroid scar is a horizontal scar on the neck. There are some techniques that surgeons use to minimise scarring. These techniques include careful incision placement and hypoallergenic suture material (to avoid inflammation). As a general rule, it is unusual to have a very noticeable scar after six months. Scars continue to fade for up to three years.
When will I know the findings of the surgery?
A final pathology report requires careful study of the surgical specimen. Therefore, the final report is usually not available until about one week after the operation.
Will I have pain after the operation?
All operations involve some discomfort, but most patients are surprised at how comfortable they feel after surgery. Although you should be able to eat and drink normally, the main complaint is sore throat and discomfort with swallowing. Most patients take Panadol or Nurofen to keep them comfortable at home. You will have a prescription for something stronger for the first few days in case you need it, but beware prescription pain medicine can make you drowsy and constipated, so do not drive or operate heavy machinery, and drink lots of water and eat plenty of fruits and vegetables.
Beginning five days after the operation, massage the scar for five minutes when you wake up, five minutes in the middle of the day, and another five minutes when you go to bed. There is good evidence that wound massage reduces pain and improves healing. Turn your head and roll your shoulders several times daily to avoid stiffness.
Will I have stitches?
You will have stitches on the inside that dissolve on their own. You will have a waterproof Comfeel dressing so that you can shower or bathe as usual (but do not submerge the incision for 5 days). Leave the dressing in place until your first post-operative visit, where it will be removed. Do not be alarmed if a small “blood blister” is visible under the dressing. If present, it will come off when the dressing is removed.
In patients prone to keloids, I use skin glue rather than sutures. The glue eventually flakes off by itself.
Will I have any physical restrictions after my surgery?
In general, your activity level depends on the amount of discomfort you experience. Many patients have resumed golf or tennis within a week after the operation. Most patients return to work in a week or two, and you are able to drive as soon as your head can be turned comfortably without prescription pain pills (this limitation is for driver safety).
What are the potential complications of thyroid surgery?
The nerves that control your voice are very closely associated with the thyroid gland. Temporary voice changes are not uncommon, but usually resolve within weeks to months. In 1 in 100 thyroid operations, the nerves that control the voice are permanently affected by the surgical removal of the thyroid. If the main voice nerve – the recurrent laryngeal nerve – is injured, your voice may be hoarse and you might have trouble being heard in a loud room. If the smaller and more delicate external branch of the superior laryngeal nerve is injured, your singing voice may be affected. When this occurs, the main difficulties are projection of the voice and production of high pitched sounds. This effect often, but not always, improves with time. Speech therapy can help as well.
Sometimes the parathyroid glands will not function after a total thyroidectomy. These are four tiny, delicate glands that are located near the thyroid. Since the parathyroid glands control calcium levels, their dysfunction results in a lowered calcium level. Therefore, many patients require calcium supplements on a temporary basis after a total thyroidectomy. If the parathyroids do not recover, calcium or vitamin D may be needed on a permanent basis. This occurs in about 2 in 100 total thyroidectomy operations. Parathyroid dysfunction does not occur if only half the thyroid is removed.
There is a small risk of bleeding into the space where the thyroid used to be. If this happens, it may be necessary to have a second operation to evacuate the blood so it does not interfere with your breathing. Infection is relatively uncommon after this operation, but is easy to treat should it occur.
WHAT ARE THE RISKS OF THYROID SURGERY?
As with anything in life, there are risks to surgery. These risks are weighed against the risks of not having surgery. Listed below are some of the possible complications of surgery. Risks include, but are not limited to:
- Permanent voice damage - 1%
- Permanent parathyroid damage - 2-4% (total thyroidectomy only)
- Infection of Incision - Less than 1%
- Haematoma or Bleeding - Less than 1%
- Seroma (fluid collection, swelling) - 5% (higher after removal of very large thyroids)
- Swelling and black/blue - About 5-10% (temporary)
- Keloid or hypertrophic scar – rare, but more common with certain skin types
- Other unforeseen risks
You will require general anaesthetic, given by a specialist anaesthetist. Risk of a serious complication in a healthy person is very rare. Potential risks include, but are not limited to:
- Heart problems (death, heart attack, arrhythmias)
- Lung problems (pneumonia, wheezing)
- Blood clots (stroke, clots in leg veins or lungs)
- Drug reactions (also possible with local anaesthetic)
- Chipped teeth
- Other unforeseen risks
You will meet the anaesthetist before your operation and have the chance to discuss these further.