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Thyroid Surgery

Thyroid surgery: Overview

Thyroid surgery takes out part or all of your thyroid gland. The gland makes hormones that control how your body makes and uses energy (metabolism).

A doctor may take out part or all of the gland when it gets too big, does not work right, or has a growth. Most growths or lumps in this gland are benign. This means they are not cancer.

During your surgery, your doctor may take out a lump or nodule. A doctor will look at the tissue under a microscope.

  • If the sample gives a clear answer for your problem, your doctor may leave the rest of your thyroid. Or you may have all of it removed.
  • If the answer is not clear, your doctor may leave the thyroid. More tests may be done on the tissue. When the test results come back, you may need surgery to take out the rest of your thyroid.

The doctor will take out the tissue, lump, or tumor through a cut (incision) in the front of your neck. You will likely have a tube, called a drain, in your neck. It lets fluid out of the cut. The drain is most often taken out before you go home.

You may go home on the same day. Or you may stay one or more nights in the hospital after surgery. You may return to work or your normal routine in 1 to 2 weeks. This depends on whether you need more treatment and how you feel. It may also depend on the kind of work you do.

Your doctor will check your incision in about a week. You may need to take thyroid medicine. If you have thyroid cancer, you may need to have radioactive iodine therapy. Your doctor will talk to you about what happens next.

  • Why surgery?

    Why is thyroid surgery done?

    Surgery is used to treat thyroid problems if:

    • Thyroid cancer is present or is suspected.
    • A noncancerous (benign) nodule is large enough to cause problems with breathing or swallowing.
    • A fluid-filled (cystic) nodule returns after being drained once or twice.
    • Hyperthyroidism cannot be treated with medicines or radioactive iodine.

    Surgery is rarely used to treat hyperthyroidism. It may be used if the thyroid gland is so big that it makes swallowing or breathing difficult or thyroid cancer has been diagnosed or is suspected. Surgery also may be done if you are pregnant or cannot tolerate antithyroid medicines.

    You may have all or part of your thyroid gland removed, depending on the reason for the surgery.

    Total thyroidectomy.

    Your surgeon will remove the entire gland and the lymph nodes surrounding the gland. Both sections (lobes) of the thyroid gland are usually removed. If you have thyroid cancer, additional treatments with thyroid-stimulating hormone (TSH) suppression and radioactive iodine work best when as much of the thyroid is removed as possible.

    Thyroid lobectomy with or without an isthmectomy.

    If your thyroid nodules are located in one lobe, your surgeon will remove only that lobe (lobectomy). With an isthmectomy, the narrow band of tissue (isthmus) that connects the two lobes also is removed. After the surgery, your nodule will be examined under a microscope to see whether there are any cancer cells. If there are cancer cells, your surgeon may perform a complete thyroidectomy.

    Subtotal (near-total) thyroidectomy.

    Your surgeon will remove one complete lobe, the isthmus, and part of the other lobe. This is used for hyperthyroidism caused by Graves' disease.

    Some surgeons are now doing endoscopic thyroidectomies using several small incisions through which a tiny camera and instruments are passed.

  • Risks

    What are the risks of thyroid surgery?

    Thyroid surgery is generally a safe surgery. But there is a risk of complications, including:

    • Hoarseness and change of voice. The nerves that control your voice can be damaged during thyroid surgery. This is less common if your surgeon has a lot of experience or if you are having a lobectomy rather than a total thyroidectomy.
    • Hypoparathyroidism. Hypoparathyroidism can occur if the parathyroid glands are mistakenly removed or damaged during a total thyroidectomy. This is not as common if you have a lobectomy.
  • Results

    How well does thyroid surgery work?

    Success of a thyroidectomy to remove thyroid cancer depends on the type of cancer and whether it has spread (metastasized) to other parts of the body. You may need follow-up treatment to help prevent the cancer from returning or to treat cancer that has spread.

    If a large noncancerous (benign) nodule causes symptoms, such as pain or problems breathing or swallowing, surgery may help relieve symptoms. All or part of the thyroid gland may be removed. Surgery may also help relieve symptoms if other treatments, such as draining a cyst (a noncancerous nodule filled with fluid), have not worked. Surgery may also be an effective treatment if you have a thyroid nodule that makes too much thyroid hormone.

  • Before surgery

    How do you prepare for thyroid surgery?

    Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

    Preparing for surgery

    • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
    • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
    • If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
    • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
    • Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
  • After surgery

    Thyroid surgery: Your recovery

    Your doctor made a cut (incision) in your neck and removed part of your thyroid gland to find what is causing a lump or to remove a growth in the gland. The piece removed may have been large or small. Your doctor may have removed all of your thyroid if there was cancer or another problem.

    He or she did a test on a small sample of the tissue from your thyroid and closed the incision in your neck with stitches.

    Keep the incision covered with the bandage and dry for 48 hours. A small amount of bleeding can be expected. Ask your doctor how much drainage to expect.

    You may go home on the same day or stay one or more nights in the hospital after surgery. You may be able to return to work or your normal routine in 1 to 2 weeks. This depends on whether you need more treatment, how you feel, and the kind of work you do.

    Your doctor will check your incision about a week after surgery. You may need to take thyroid medicine. If you have thyroid cancer, you may need to have radioactive iodine therapy. Your doctor will talk to you about what happens next.

    You will feel some pain for several days. You may have some nausea and general muscle aches and may feel tired for 1 to 2 days. You also may have a sore throat and sound hoarse.

    How can you care for yourself after thyroid surgery?

    Activity

    • Rest when you feel tired. Getting enough sleep will help you recover.
    • Most people are able to return to work a few days after surgery, but this can depend on what type of work you do.

    Diet

    • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

    Medicines

    • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
    • If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
    • Suck on throat lozenges or gargle with warm salt water to help your sore throat.
    • Be safe with medicines. Take pain medicines exactly as directed.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • If you think your pain medicine is making you sick to your stomach:
      • Take your medicine after meals (unless your doctor has told you not to).
      • Ask your doctor for a different pain medicine.

    Incision care

    • If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off. Or follow your doctor’s instructions for removing the tape.
    • Keep the area clean and dry.
    • You will have a dressing over the cut (incision). A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.

    Exercise

    • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.

    Elevation

    • You may be more comfortable if you keep your head up on a pillow when you lie down. Support the back of your head and neck with both hands when you sit up to prevent discomfort.

    After thyroid surgery: When to call

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You have severe trouble breathing.

    Call your doctor now or seek immediate medical care if:

    • You have a lot of bleeding through the bandage.
    • You have a hard time swallowing.
    • You have trouble breathing.
    • You have new or worsening pain.
    • You have symptoms of infection, such as:
      • Increased pain, swelling, warmth, or redness.
      • Red streaks leading from the incision.
      • Pus draining from the incision.
      • A fever.

    Watch closely for any changes in your health, and be sure to contact your doctor if:

    • You’re not getting better as expected.
    • You notice a change in your voice.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.