With thyroid surgery it is sometimes necessary to remove one or more of the parathyroid glands, and then the blood calcium level may fall below normal. If or when this happens you will be advised to take additional calcium and sometimes vitamin D as well. Usually this is only for a few weeks, but in 1-2% of cases it is permanent.
Will it affect my voice?
The thyroid gland lies close to the voice box (larynx) and the nerves to the voice box. Following your surgery you may find that your voice sounds hoarse and weak and your singing voice may be slightly altered, but this generally recovers quite quickly. In a very small number of cases this voice change may be permanent.
The main nerve that goes to the larynx is the recurrent laryngeal nerve. Dr McIvor’s incidence of temporary injury to this nerve is around 1% and the rate of permanent injury is less than that. Occasionally the nerve is involved by cancer and requires removal which causes a weak and breathy voice. Dr McIvor is also a specialist in voice surgery and he can do a small operation under local anesthetic with sedation that will return the voice to close to normal.
Will my calcium levels be affected following thyroid surgery?
The parathyroid glands are situated close to the thyroid and control the level of calcium in the blood. There are usually 2 glands on each side and only one is needed to have normal calcium levels.
Following hemi-thyroidectomy, providing the other side has never been operated on, calcium problems are extremely unlikely as there will be normal glands on the un-operated side.
Sometimes after total thyroidectomy all the parathyroid glands are affected and you may experience tingling sensations in the hands, fingers, in your lips or around the nose. Sometimes people may feel quite unwell. Blood tests will be taken to monitor the levels of calcium in your blood immediately following surgery and again the next day.
After total thyroid removal if the level of calcium is falling, this can easily be treated by calcium supplementse given via an intravenous drip and/or by tablets. Around 10% of patients need to take these tablets temporarily for a few weeks until the parathyroids recover. Only 1-2% of patients require permanent calcium supplementation.
If you are placed on calcium supplements, you may need to have blood tests to check calcium twice a week for a few weeks. Dr McIvor will advise you on this.
Will my calcium levels be affected following thyroid surgery?
The parathyroid glands are situated close to the thyroid and control the level of calcium in the blood. There are usually 2 glands on each side and only one is needed to have normal calcium levels.
Following hemi-thyroidectomy, providing the other side has never been operated on, calcium problems are extremely unlikely as there will be normal glands on the un-operated side.
Sometimes after total thyroidectomy all the parathyroid glands are affected and you may experience tingling sensations in the hands, fingers, in your lips or around the nose. Sometimes people may feel quite unwell. Blood tests will be taken to monitor the levels of calcium in your blood immediately following surgery and again the next day.
After total thyroid removal if the level of calcium is falling, this can easily be treated by calcium supplementse given via an intravenous drip and/or by tablets. Around 10% of patients need to take these tablets temporarily for a few weeks until the parathyroids recover. Only 1-2% of patients require permanent calcium supplementation.
If you are placed on calcium supplements, you may need to have blood tests to check calcium twice a week for a few weeks. Dr McIvor will advise you on this.
Will I have neck stiffness, restricted shoulder movement or pain?
You will feel some discomfort and stiffness around your neck but you will be given some medication to help ease this. Pain relief may be given in different ways, such as injections, liquid medicine or tablets. Most patients say the discomfort is not as bad as they expected, and after the first day are up and walking around. You will also be given some gentle neck exercises to do.
Following discharge on the first or second day Dr McIvor prescribes paracetamol and an anti-inflammatory for 5 days which suffices for any discomfort. After a few weeks you should be back to a good standard of neck movement and shoulder function.
Will I have a scar?
Following surgery, whether all or part of your thyroid is removed, you will have a scar, but once this is healed it is usually not very noticeable. The scar runs in the same direction as the natural lines of the skin on your neck. The pressure of rubbing the cream in will also help to soften the scar. If your neck becomes increasingly painful, red or swollen or you notice any discharge then please seek medical advice from Dr McIvor or your GP
What are the costs for thyroidectomy?
There are generally 3 costs for any procedure: surgeon’s fee, anesthetist’s fee, hospital fee. These are given separately by the surgeon, the anaesthetist and the hospital and are to be paid separately.
Dr McIvor’s secretary will give or post to you an estimate for all three of these costs. It is important that you discuss this with your insurance company prior to coming into hospital.
The hospital account is to be paid at the time of discharge from the hospital. The anaesthetic and surgeon fees should be settled on receipt of the account through the post or at the post-operative appointment.
How will I feel after the operation?
Surprisingly good is the answer. I have had thyroid surgery so I know. My anaesthetist Graeme Crookes also put me to sleep for my thyroid operation. He is excellent. Once you are asleep, Graeme puts lots of local anesthetic into the neck around the operation site to reduce pain during the procedure. That way he doesn’t have to give heavy pain-killers and as a result you have a lighter anesthetic and wake up faster.
You can eat and drink and receive visitors on the evening of surgery. If there is a drain it is usually kept in overnight. There may be a sensation of mucus in the throat that causes you to “ahem” a bit over the first week. Paracetamol and maybe an anti-inflammatory for a few days is all the pain relief required.
Despite all this you should plan a week and preferably 10 days off work as anesthetics tend to make you a bit tired.
What care do I need to take regarding my neck wound?
Keep your neck wound clean and dry. There will be a paper tape over the wound to protect the wound.
After your skin tapes are removed at your one week appointment and the scar is healing well you can rub a small amount of unscented moisturising cream on the scar so it is less dry as it heals. Vitamin A, Vitamin E, Bio-oil , or Aloe Vera are effective. Take care not to knock your wound and remember to keep the wound dry if it becomes wet after bathing or showering by patting it dry with a clean towel.
What rest do I need and when should I return to work?
You will need to take it easy while your neck wound is healing. This means avoiding strenuous activity and heavy lifting for a couple of weeks. The wound area will gradually feel less stiff and you will soon be able to enjoy your normal activities.
You will probably need to take one to two weeks off work (or sometimes longer) depending on your occupation and the nature of your work. Dr McIvor can issue you with a note for two weeks and then you should see your GP if more time is required.
What about my medications and tablets?
Please continue to take the medication you have been prescribed and ensure that you have a good supply. If you are unsure about any of the tablets you need to take, please check this with a nurse before you go home. Repeat prescriptions can be obtained from your GP.
What follow-up will there be?
Following your discharge you will need to be reviewed in the outpatient clinic to check how your wound is settling down, your hormone levels and how you are feeling. You will usually receive the date and time for this appointment through the post or by phone from Dr McIvor’s secretary. Please contact Dr McIvor’s secretary 09 4887349 if you do not receive one shortly following discharge.
Depending on the problem with your thyroid and the results from the thyroid tissue that has been removed, you may be offered further treatment. Dr McIvor will be discuss this with you at your clinic appointment.
- In the event of a hemithyroidectomy for benign disease, a blood test will be arranged for one month to check that the remaining thyroid tissue is producing enough thyroid hormone for your requirementys.
- Following total thyroidectomy, a blood test will be arranged for one month to check that the dose of thyroxine is sufficient. This will be re-checked in a further 6 weeks or so and then at regular intervals. Ultimately once the thyroxine dose is stabilized an annual check will suffice.
- If you are on calcium supplements blood tests for calcium will be initially twice a week.
If you have had thyroid surgery for cancer then you may need further treatment (e.g. radioiodine therapy) and an appointment will be arranged for you with an endocrinologist to discuss this further. Surveillance will be lifelong with most patients ending up with an annual check-up.
