WHAT TO EXPECT THYROID SURGERY

BEFORE THE SURGERY

If you are suffering from hyerthyroidism (overactive thyroid), you may need to take (or continue to take) medications to control your hormone levels in the weeks before surgery. Surgery is safest if your thyroid hormone levels are normal at the time of the operation.

Sometime before surgery you will likely have blood tests, a chest x-ray, and an electrocardiogram (ECG) test to ensure you are fit for surgery. At some hospitals you may be offered a pre-operative check of your vocal cords to check they are functioning correctly and assess whether there is any increased risk of harm to them during the operation. 

If it’s determined that you need surgery, you will visit a surgeon who will explain how your minimally invasive surgery will be performed, including where the incisions will be made. You may be having just one lobe of your thyroid removed (a lobectomy), almost all the thyroid removed (a sub-total/near-total thyroidectomy) or the entire thyroid removed (total thyroidectomy).

In preparation for surgery, you will be asked not to eat anything after the evening meal the day before your operation. 

If you are having thyroid surgery because your doctor thinks you may have thyroid cancer, the surgeon may also remove some of the lymph nodes close to the thyroid. The extent of the operation in this case will not be known. Your surgeon will need to examine your thyroid and the lymph nodes during the operation in order to decide how much needs to be removed. 

Your anesthesiologist will explain how the anesthetic will be given. In traditional thyroid surgery, you will have a general anesthetic and will be asleep during the operation.  For minimally invasive thyroid surgery, you may only need a local anesthetic, in which only your neck area is numbed. In this case, you will also get mild sedatives so that you will not feel anxious. With this type of anesthetic, you will be able to communicate with the surgeon during the operation.

DURING THE SURGERY

An uncomplicated total thyroidectomy should take less than 2 hours to perform. If you are having a less extensive operation, it will be quicker. During the surgery, your surgeon may use a nerve monitoring system to help reduce the risk of nerve injury to the nerves controlling your voice. The system allows the surgeon to locate the nerves that run close to your thyroid and also to test their functioning during surgery, thereby reducing the risk of damage.

AFTER THE SURGERY

When you wake up from the anesthesia, you will likely be in a special recovery area where the nurses can monitor you closely until you are fully awake. Small tubes going into your body will temporarily provide fluids until you can drink again, as well as drain any excess fluid from the incision area. These tubes will be removed the same day or the next day, depending on the extent of the operation and the speed of your recovery. 

You will have some stitches where the incision was made. These will dissolve over a few weeks. Your neck and throat will be sore and stiff for a few days. You will be given pain medicine while you’re at the hospital and to take home with you. The pain will ease and stop within a few days. 

You may notice some changes to your voice, which can happen if the nerves supplying your voice box (larynx) are damaged in any way during the operation. These changes should only last a few days. Using a nerve monitoring system helps surgeons reduce the risk of nerve injury during surgery. You may also have a laryngoscopic examination of your vocal cords to ensure they are functioning correctly. 

Your healthcare team will request that you to get up and about soon after surgery — probably the next day. You will be given exercises to help with the stiffness in your neck. You will also be given some leg and breathing exercises to make sure your circulation and lungs are working well and to help prevent any infections or blood clots after the operation. 

You will probably be ready to go home one or two days after your operation.