Post-Thyroidectomy Side Effects & Recuperation

young woman touching her neck in pain
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If you are having thyroid surgery, known as a thyroidectomy, it's important to know what to expect in terms of side effects, potential complications, and the recuperation process.

Post-Surgical Side Effects

After your thyroid surgery, whether you remain in the hospital overnight or are having outpatient surgery, you will typically spend several hours in the recovery room. This way your healthcare team can monitor and manage your pain and watch out for for any immediate post-surgical complications like bleeding into the neck (called a hematoma).

Once out of the recovery room, do not be alarmed if you experience some of these short-term, but less serious side effects:

  • Neck tension and tenderness: Your tendency may be to hold your head stiffly in one position after surgery, and this can cause neck and muscle tension. It's good to do gentle stretching and range of motion exercises to prevent muscle stiffness in the neck area. Simply turning your head to the right, then rolling your chin across the chest until your head is facing left can help loosen tight muscles.
  • Voice problems: Your voice may be hoarse, whispery, or tired.
  • Swallowing Problems: Swallowing problems (called dysphagia) is a common complaint after thyroid surgery.
  • Irritated windpipe: Due to a breathing tube placed under general anesthesia, your windpipe may feel irritated, like there is something stuck in your throat.

Complications After Surgery 

Thyroid surgery is considered extremely safe. While complications are not common, some people are at a higher risk for developing them. These risk factors include:

  • Undergoing surgery for a very large goiter
  • Having a full thyroidectomy, meaning the entire thyroid gland is removed, rather than a lobectomy
  • Undergoing a central neck dissection for thyroid cancer, which involves removing lymph nodes and lymph tissue around the thyroid
  • Undergoing a repeat thyroid surgery

It's a good idea to carefully discuss your risk factors and review all potential complications prior to surgery with your doctor. Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. With that, it's a good idea to discuss with your surgeon how many thyroidectomies he or she has performed in the past, and his or her complication rate.

Moving on, some potential complications of thyroid surgery include the following:

Hematoma

A neck hematoma (bleeding into the tissue surrounding the neck) is a rare, but potentially life-threatening complication of thyroid surgery, appearing as a large and firm area of swelling on the side of or in the front of the neck underneath the surgical incision site. If a hematoma does form, it usually occurs within six or so hours after surgery, but it may occur within the first day or two, as well. Treatment entails surgical removal of the hematoma.

Hypoparathyroidism and Hypocalcemia

Hypoparathyroidism means that the parathyroid glands, of which there are four located behind your thyroid gland, are under-functioning. The parathyroid glands normally work to control your body's calcium levels. If the parathyroids are damaged or nicked during surgery, this trauma can cause temporary or permanent shutdown, which results in a lowered calcium level in the body, called hypocalcemia.

Permanent hypoparathyroidism is rare, affecting approximately 2 percent of patients after a thyroidectomy by an experienced surgeon. On the other hand, transient hypoparathyroidism and hypocalcemia is common after surgery, causing possible symptoms like a numbness and tingling feeling around your lips, hands, and the bottom of your feet, or muscle cramps and twitches.

If these symptoms do occur, they usually do so in the day or two after surgery and then resolve. To ease these symptoms or prevent them from occurring in the first place, your doctor may recommend temporary calcium supplementation. Rarely, if the calcium level is persistently low despite oral calcium supplementation, a person may require intravenous (through the vein) calcium in the hospital.

Recurrent Laryngeal Nerve Injury

While some people experience mild hoarseness after thyroid surgery, this should resolve on its own within a day or two. If hoarseness persists, a surgical complication called recurrent laryngeal nerve injury may have occurred. The recurrent laryngeal nerve is the nerve that supplies the muscles which move the vocal cords.

Besides persistent hoarseness, uncontrolled coughing when speaking, difficulty breathing for more than 24 or 48 hours after surgery, or the development of aspiration pneumonia post-operatively requires an immediate evaluation by an ear, nose, and throat (ENT) doctor. The ENT doctor will perform a procedure called a direct laryngoscopy to visualize the vocal cords.

Recuperation Time

While you should be able to return to driving and participating in other normal, everyday activities, as soon as you can turn your head normally and without pain or difficulty, your surgeon will want you to avoid vigorous activity, like swimming or heavy lifting, as well as any other major physical activities for ten to fourteen days. The restriction on more strenuous activities is to prevent a neck hematoma (bleeding into the neck) from forming and to allow the wound from surgery to heal properly.

Generally speaking, you will usually need to return to the surgeon for a follow-up visit around one to two weeks after surgery. In the meantime, be sure to contact your thyroid care team if you have any questions regarding your recovery process.

Caring for Your Incision 

While the coating applied over your incision will make it possible for you to bathe or shower after the surgery, you should not submerge, soak, or scrub your incision. After showering, you may want to use a hair dryer set to "cool" to dry the incision.

The coating over your incision will usually turn white and peel off within a week. Once the coating falls off, you can start using a scar gel, aloe, or cocoa butter to help with healing and minimize itching. You might notice bruising or slight swelling around the scar. If you notice any significant swelling, you should contact your surgeon right away, as that could be a sign of infection. Over time, the scar may take on a pink color and feel hard. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months.

Hormone Replacement

Patients receiving a total thyroidectomy, and some patients receiving a subtotal thyroidectomy (partial removal of the gland), will need prescription thyroid replacement drugs. Your doctor may not discuss this with you, so be sure to have a conversation with him or her about when you will start thyroid medication, which medication, and at what dosage before you are discharged from the hospital.

If you are not immediately put on thyroid hormone medication (likely because you only had part of your thyroid gland removed), watch carefully for symptoms of hypothyroidism, and contact your doctor if any of them do occur.

There are many symptoms of hypothyroidism, but some of the more common ones include:

  • Feeling cold, especially in the extremeties
  • Dry, coarse skin
  • Unexplained or excessive weight gain
  • Fatigue and sluggishness
  • Constipation
  • Muscle cramps
  • Increased menstrual flow and more frequent periods
  • Depression and difficulty concentrating 

A Word From Verywell

Knowing what to expect before your thyroid surgery is helpful for coping with potential side effects, reducing complications, and undergoing an easier recovery process. As with any surgery, it's normal to have questions, concerns, and maybe even feel a little bit of anxiety going into it. Discuss what's on your mind with your doctor.

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