What are the risks of the operation?
The most serious possible risks of thyroid surgery include:
- Bleeding that can cause acute respiratory distress.
- Injury to the recurrent laryngeal nerve that can cause permanent hoarseness, and breathing problems with possible tracheotomy in rare cases if injury is sustained on both sides.
- Damage to the parathyroid glands that control calcium levels in the body, causing hypoparathyroidism and hypocalcemia.
These complications occur more frequently in patients with invasive tumors or extensive lymph node involvement, in patients requiring a second thyroid surgery, and in patients with large goiters that go below the collarbone. Overall the risk of any serious complication should be less than 2%. Prior to surgery, patients should understand the reasons for the operation, the alternative methods of treatment, and the potential risks and benefits of the operation.
How much of my thyroid gland needs to be removed?
Your surgeon should explain the planned thyroid operation, such as lobectomy (hemi) or total thyroidectomy, and the reasons why such a procedure is recommended. For patients with papillary or follicular thyroid cancer many, but not all, surgeons recommend total or near total thyroidectomy when they believe that subsequent treatment with radioactive iodine might be beneficial. For patients with large (>1.5 cm) or more aggressive cancers and for patients with medullary thyroid cancer, more extensive lymph node dissection is necessary to remove possibly involved lymph node metastases. Thyroid lobectomy may be recommended for overactive one-sided nodules or for benign one-sided nodules that are causing symptoms such as compression, hoarseness, shortness of breath or difficulty swallowing. A total or near– total thyroidectomy may be recommended for patients with Graves’ disease or for patients with enlarged multi nodular goiters.
Will I need to take a thyroid pill after my operation?
The answer to this depends on how much of the thyroid gland is removed. If half (hemi) thyroidectomy is performed, there is an 80% chance you will not require a thyroid pill UNLESS you are already on thyroid medication for low thyroid (Hashimoto’s thyroiditis). If you have your entire (total) or remaining (completion) thyroidectomy, then you have no internal source of thyroid hormone remaining and you will need lifelong thyroid hormone replacement.
What will be my physical restrictions following surgery?
Most surgeons prefer a brief limitation is extreme physical activities following surgery. This is primarily to reduce the risk of a post-operative neck hematoma (blood clot) and breaking of stitches in the wound closure. These limitations are brief, usually followed by a quick transition back to unrestricted activity. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days to 2 weeks.
Will I be able to lead a normal life after surgery?
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to doing anything that you could do prior to surgery. Some patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone. This is especially true if you had your whole thyroid gland removed. Thyroid hormone replacement therapy might be delayed for several weeks if you are to receive radioactive iodine (RAI) therapy unless there is a plan for you to receive TSH injection prior to RAI.
