Thyroid Surgery Recovery, Side Effects, and Complications

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If you are having thyroid surgery, known as a thyroidectomy, it's important to know what to expect as you recover. Side effects of surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism. Complications are much less common and can include bleeding (a neck hematoma), permanent hypoparathyroidism (necessitating long-term calcium replacement), and damage to nerves that can lead to long-term hoarseness and vocal changes.

Taking time to learn about post-thyroidectomy recovery can prepare you to cope with any symptoms and to be alert to any problems.

thyroidectomy side effects and complications
Illustration by Brianna Gilmartin, Verywell

Side Effects

There are a number of short-term side effects that people may experience after thyroid surgery. Most of these will be temporary, but some may persist. Common side effects beginning after surgery include:

Nausea and Vomiting

Nausea and vomiting after thyroidectomy was the norm at one time, and people may be concerned if they talk with others who had this procedure in the past. Fortunately, the use of medications such as dexamethasone has greatly reduced the incidence of vomiting, and if nausea does develop, there are treatments that can alleviate your symptoms.

Neck Pain and Stiffness

The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.

Many surgeons recommend doing gentle stretching and range-of-motion exercises, such as the following, to reduce stiffness. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises she believes might be helpful, how often you should perform them, and whether there are any exercises you should avoid.

  • Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
  • Gently tilt your head to the right and then to the left.
  • Rotate both shoulders forward in a circular motion.
  • Slowly raise your arms overhead, and then slowly lower them back down against your body.

Suggested frequency: 10 repetitions, three times day

Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours does not, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation (a physiatrist) or a physical therapist who can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility to normal.

A Sore Throat

Thyroid surgery is often done under general anesthesia with a breathing tube placed in the windpipe to breathe for you. This can lead to a sore throat and the sensation of a lump (like something is stuck in your throat) with swallowing. Using a throat spray or lozenges can help with the discomfort until you are healed.

Difficulty Swallowing

Swallowing problems (dysphagia) are a common symptom after thyroid surgery, though they're usually transient. Eating soft foods for the first few days can be helpful. Examples include foods with sauces or gravy, cooked vegetables, and casseroles.

Hoarseness and Voice Problems

After surgery, your voice may be hoarse or whispery, and it may feel tiring to talk. This is very common and expected during the first week or two after surgery. While around 1 percent of people may have damage to the nerves supplying the vocal cords, around 5 percent to 10 percent of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward.

Symptoms usually improve in the first few weeks but may persist up to six months after surgery. While there is no specific treatment for transient hoarseness, it's helpful for your loved ones to be aware of the problem so that you don't feel the need to talk loudly or more often than is comfortable. If the nerve was injured, more severe symptoms may be noted after surgery.

Transient Hypoparathyroidism

The four parathyroid glands lie on the back of the thyroid gland and are sometimes injured or removed during surgery. These glands are responsible for controlling the body's calcium levels. Even when these glands are not damaged, however, roughly 5 percent of people may have temporary symptoms of a low calcium level (hypocalcemia), and this can persist for up to six months.

Since it's common for the parathyroid glands to function poorly after a thyroidectomy, you may be sent home with calcium and vitamin D supplements to use. When you have your follow-up appointment, your surgeon will check your blood calcium level. If you are not given calcium, it's important to be aware of the symptoms of hypocalcemia, which often include numbness and tingling around the mouth and in the fingers.

Most often calcium levels improve in a few weeks but may continue to be low for up to six months. During this time, your doctor will monitor your calcium levels to determine when you can stop using your supplements (or much less commonly, if you will need to continue these indefinitely).

A 2018 study found that giving potassium iodide during thyroid surgery was associated with less transient hypoparathyroidism and hoarseness (and may improve the safety of the procedure for those with Grave's disease). You can ask your surgeon about this prior to your surgery.

Hypothyroidism

People who have a total thyroidectomy will require prescription thyroid replacement therapy after their procedure. With a subtotal thyroidectomy, hypothyroidism is less common, affecting roughly 20 percent of people who have the procedure.

If your doctor prescribes thyroid replacement therapy, be sure to have a conversation with her before leaving the hospital about when to start the medication, which medication you need, and at what dosage. It's also important to talk about how to properly take your medication, as food and many drugs and supplements can interfere with absorption.

If you had a subtotal thyroidectomy and are not immediately put on thyroid hormone medications, watch carefully for symptoms of hypothyroidism and contact your doctor if they occur. Having regular thyroid testing done is also important, as hypothyroidism may not occur right away, or even for months or years.

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

  • Feeling cold, especially in the extremities
  • 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

Complications

Though thyroid surgery is considered a relatively safe procedure, complications may sometimes occur. Some of these require prompt treatment, so it's important to be aware of their potential.

Hematoma

Bleeding into the tissues surrounding the neck (a neck hematoma) is uncommon, but is potentially life-threatening if not diagnosed and treated promptly. Occurring in roughly one in 300 procedures, most hematomas occur within 24 hours of surgery, though research indicates they may occur later in 10 percent to 28 percent of cases.

Symptoms may include an area of firmness and swelling on the front or side of the neck (usually beneath the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, lightheadedness, or stridor (a high-pitched wheezing sound that's usually most noticeable with inspiration than exhalation).

If you experience any swelling of your neck, increasing pain, shortness of breath, or difficulty breathing, seek immediate medical attention.

Treatment includes immediate surgery to remove the hematoma and address any areas of bleeding.

Permanent Hypoparathyroidism

While temporary in some cases, hypoparathyroidism caused by the injury or removal of parathyroid glands can be permanent. As only one of the four parathyroid glands is needed to regulate calcium levels, the condition is uncommon, affecting roughly 2 percent of people who have a thyroidectomy.

Factors that increase the risk of hypoparathyroidism after thyroid surgery include a diagnosis of thyroid cancer, a longer duration of thyroid disease before surgery, a central incision, and the removal of a large amount of thyroid tissue.

If calcium supplementation is not used and the condition is permanent, further symptoms may include tingling and numbness of the bottoms of the feet, muscle cramps and twitches, anxiety, depression, and headaches. If hypocalcemia is severe, the condition can progress to symptoms of abnormal heart rhythms (arrhythmias), difficulty breathing (due to muscle spasms in the larynx), kidney stones, heart failure, and/or seizures. As with other side effects and complications, the timing of symptoms can vary from one person to the next.

Most often, lifelong calcium supplementation is all that is needed. But if severe symptoms occur, intravenous calcium in the hospital may be required.

Laryngeal Nerve Injury

Roughly 1 percent of people having a thyroidectomy will experience damage to either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. If hoarseness persists, especially if it is still present six months after surgery, it's likely that the recurrent laryngeal nerve was injured. This nerve controls the muscles that move the vocal cords.

In addition to persistent hoarseness, injury to the recurrent laryngeal nerve may lead to other symptoms after surgery. These can include uncontrolled coughing when speaking, difficulty breathing, or the development of aspiration pneumonia.

If any of these symptoms occur, immediate evaluation by an ear, nose, and throat (ENT) doctor is recommended. The ENT doctor will perform a procedure called a direct laryngoscopy to visualize the vocal cords and see if a tracheostomy is needed. This is uncommon and primarily a concern if both nerves are damaged.

Injury to the external branch of the superior laryngeal nerve is usually less obvious. When injured, a person may have difficulty making high-pitched noises or yelling, though their routine speaking voice may be unchanged.

Infection

The risk of infection is present with any type of surgery but is relatively rare with thyroid surgery (roughly one in 2000 surgeries). Treatment usually includes IV antibiotics.

Seroma

A seroma is a collection of fluid that can occur after many types of surgery. While the fluid is often reabsorbed by the body, large seromas may need to be drained.

Thyroid Storm

Thyroid storm or thyrotoxic crisis is a condition caused by very high levels of circulating thyroid hormone. It is uncommon, but when it occurs after thyroidectomy, is usually associated with Grave's disease. Symptoms include a fever (over 102 degrees F in most people), profuse sweating, a rapid heart rate, and sometimes delirium.

The use of iodine was thought to reduce the risk, but a 2017 study questioned the benefit. Treatment (in the intensive care unit) includes cooling, intravenous fluids, medications such as propylthiouracil, and management of arrhythmias.

Anesthesia Risks

Possible complications of general anesthesia may also occur since most thyroidectomies require it.

Risk Factors

While complications can affect anyone, there are some risk factors that increase the chance of the adverse effects. These include:

  • Being older than age 70
  • Smoking
  • The presence of other medical conditions, such as congestive heart failure or a bleeding disorder
  • Thyroid cancer, especially when a central neck dissection is done to remove lymph nodes
  • Repeat thyroid surgery

While a total thyroidectomy is more extensive surgery than a subtotal thyroidectomy, several studies, including a 2016 review, suggest that the safety of the two procedures is similar with regard to complications, though transient low calcium levels (and hypothyroidism due to the removal of the entire thyroid) are more common with the total procedure.

Inpatient vs. Outpatient

There has been some controversy over inpatient vs. outpatient thyroidectomies, especially with the recent trend toward same-day surgery. The primary reason for concern is that bleeding (neck hematomas), which can be life-threatening, may occur after a person has returned home after outpatient surgery. As far as safety, a 2018 study suggests that outpatient surgery may be safe, but the researchers admitted that the study may be biased (people who were are at greater risk are more likely to be hospitalized, whereas those at lower risk were more likely to be offered the procedure on an outpatient basis).

Physician Volume and Expertise

Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. With this in mind, it's a good idea to ask your surgeon how many thyroidectomies she has performed in the past. You may also wish to ask about her complication rate, but this is not necessarily an accurate measure of competence (more experienced surgeons may agree to take on more challenging cases that are likely to have a higher complication rate, and less experienced surgeons may limit themselves to low-risk cases).

Recovery

After surgery, you will be monitored in the recovery room, sometimes for up to six hours. During this time, the staff will monitor you closely for any signs of neck swelling that could indicate a neck hematoma.

You may remain in the hospital overnight or be allowed to return home if you had outpatient surgery and are stable. The head of your bed will be raised to reduce swelling, and you will be allowed to eat a regular diet. If your throat is sore or if swallowing is painful, eating a diet of soft foods will be more comfortable.

Before you leave the hospital, your nurse will go over any instructions and talk about when you should follow up with your surgeon. Be sure that you know what your at-home treatment regimen entails (medication, supplementation) and how to take any pain medications prescribed, if applicable. Keep in mind that pain medications can cause constipation, and your doctor may recommend a stool softener and/or laxative.

Recuperation Time and Restrictions

Most people are advised to take roughly two weeks off from work to recuperate, depending on their occupation. You should not drive as long as you continue to need pain medications, and some surgeons recommend abstaining from driving for the first week after surgery altogether.

You should also avoid any heavy lifting or strenuous activities (such as many sports) for a few weeks. The excess activity could increase your chance of developing a hematoma or keep your wound from healing properly. Light housekeeping and walking are usually fine once you arrive home.

Caring for Your Incision 

Your surgeon will talk to you about whether you should continue to wear a dressing over your incision. Depending on the surgeon, you may have stitches that will need to be removed or absorbable sutures that will not. If steri-strips were applied, these will usually stay in place for around a week. Most surgeons recommend leaving these alone until they fall off by themselves, rather than trying to remove them.

You will probably be able to shower, but should try to keep your neck as dry as possible. You should not submerge, soak, or scrub your incision, and bathing in a tub should be avoided until you see your surgeon. After showering, you can lightly pat your neck dry or use a hair dryer set on the "cool" setting.

Your incision may appear red and hard at first, and you may notice some slight swelling and bruising around the scar. If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months.

In time, your incision will turn pink and then white, and most are completely healed in six to nine months.

Since the area around your incision will be prone to sunburns, wear sunscreen whenever you go outside for at least a year after surgery. If you are wondering what your scar may look like, the University of California Los Angeles has a scar gallery with photos of people who have had thyroid surgery at various points in the healing process.

Follow-Up

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.

At your follow-up appointment, your surgeon will determine if you need to remain on calcium and vitamin D if they were prescribed. If you were started on hormone replacement therapy, a TSH should be checked about six weeks after surgery.

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. Keep in mind that even when complications occur, which is not common, prompt treatment can often restore your health to normal.

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