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Thyroid and Parathyroid Specialist

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Total Thyroidectomy

total-thyroidectomy

Total Thyroidectomy

The thyroid gland helps control your metabolism. Total thyroidectomy surgery removes the entire thyroid gland. This is a safe operation with a minimal risk of damaging either the parathyroids or the laryngeal nerves. There are several reasons why total thyroidectomy surgery may be needed including:

  • Multinodular goitre
  • Thyroid compression symptoms / Retrosternal goitre
  • Hyperthyroidism
  • Thyroid cancer
  • Cosmetic reasons such as an unsightly lump in the front of the neck

Aims of total thyroidectomy surgery

  • To make an accurate diagnosis by sending the whole thyroid gland for pathology testing
  • To relieve pressure and compression symptoms when the thyroid gland is pressing on the trachea and / or oesophagus
  • To correct hyperthyroidism when medical management is unsuccessful

Anaesthesia for Total Thyroidectomy

  • Total thyroidectomy is routinely performed under general anaesthesia
  • The anaesthetic is given by a specialist Anaesthetist
  • Modern anaesthesia is safe, however, rarely serious reactions to anaesthesia occur
  • If you have ever had a reaction to an anaesthetic drug tell your Anaesthetist and Surgeon
  • Your Anaesthetist will be able to explain which anaesthetic is best and the associated risks and benefits

The Incision for total Thyroidectomy surgery

A horizontal skin incision is made in one of the lower neck skin creases. The incision is routinely closed with dissolving sutures and then taped with micropore. With routine wound care including taping in the early post-operative period the scar usually settles to blend in with the skin creases.

Recovery

The in-hospital length of stay after total thyroidectomy is usually one night and the length of time off work is variable but often one to two weeks. Most people recover fairly quickly after total thyroidectomy and resume normal activities within one to two weeks. A post-operative visit at two to three weeks is routine to review the results – you will need to contact the office to make an appointment for that visit. You will also need to be reviewed by your local doctor or endocrinologist at around 6 weeks and have thyroid function tests to check the function of your remaining thyroid.

General advice after thyroid surgery

Antibiotics and pain medications may be prescribed and should be taken as directed. Do not take aspirin or aspirin based products or Ibuprofen for 10 days after thyroid surgery. You may shower, bathe etc as you normally would.

Wound care after thyroid surgery

Your wound will be covered with Steri-Strips which be removed at your first post-operative visit. You can wash and shower with the Steri-Strips in place and even get them wet. Once the Steri-Strips are removed, you will need to tape the wound and change it every 2 or 3 days for the next 2 to 3 months in order to get the best possible cosmetic result. The preferred tape is narrow, skin coloured Micropore which can be obtained from your chemist.

Activities

Bending, straining, heavy lifting and strenuous exercise should be avoided for around seven days after surgery. Activities, which involve turning the head suddenly, such as driving in heavy traffic, should be avoided although local driving is acceptable. Commonsense is the best way to avoid straining your neck.

Thyroid hormone replacement – Thyroxine medication

You will need to take thyroxine for life. The initial dose will be checked by your endocrinologist at 6 weeks and adjusted if necessary. Thyroxine is best taken half an hour before breakfast and should not be taken with your calcium supplements which are best taken with meals.

Calcium supplements

  • A temporary drop in calcium levels is very common after total thyroidectomy
  • The calcium level is checked in hospital and if it is normal, you will be sent home just on calcium supplements (Caltrate)
  • If the calcium level is low, you may also be sent home on vitamin D tablets (Rocaltrol) as well as Caltrate
  • You will need to see your local doctor every week after discharge to have a blood test and to have the calcium levels checked
  • If the calcium level in the blood is normal, then the dose needs to be reduced

Local symptoms after thyroid surgery

  • A variety of local symptoms are common for several weeks after surgery including neck tightness, choking, or problems with eating and drinking
  • Headaches and tiredness are also common as is weakness of the voice with prolonged use
  • Occasionally a symptom may last for months
  • Swelling of the neck around the wound is also common and may benefit from daily massage with Vitamin E or Sorbolene cream
  • Numbness of the skin above the wound may be present and may last for many months

Late complications

The main delayed complication of concern is wound infection. Signs that this may have occurred include the wound becoming very red, hot and more swollen. If that occurs you must seek attention from your local doctor straight away who will arrange for you to have antibiotics.

Follow-up

Generally your follow-up after total thyroidectomy will consist of:

  • A visit at 2 to 3 weeks to have the tape removed – you will need to ring the office to make an appointment for that visit
  • Α final surgical check up at 3 months
  • In addition you may need to be seen by your local doctor on a weekly basis to have a blood test to check your calcium level, and to have your calcium supplements progressively reduced
  • You will also need to be reviewed by your local doctor or endocrinologist at around 6 weeks and have thyroid function tests to check your thyroxine (Oroxine) dose – which may need to be adjusted
  • Your local doctor or endocrinologist may need to see you more frequently for specific review if there are any problems

If you have any problems, following your thyroid surgery, you should speak to your local doctor, who will arrange to contact your surgeon – this includes:

  • Fever greater than 38.5 degrees for more than 24 hours
  • An increase in swelling or redness around the incision area
  • Increased pain and tenderness not controlled by pain medication
  • Numbness, tingling or twitching in the face or hands
  • Hoarseness or breathing problems

If you have any questions about thyroid surgery or total thyroidectomy, you should speak to your local doctor, who will arrange to contact your thyroid surgeon.