Thyroid Surgery and Postoperative Care

Thyroid surgery, in which part or all of the thyroid gland is removed, is the most commonly used method in the treatment of benign and malignant thyroid diseases. Although today it is a safe and well-established operation, it requires care because the gland lies close to the nerves that move the vocal cords and to the parathyroid glands, which regulate calcium balance.

Types of operation

• Lobectomy (hemithyroidectomy): One lobe of the gland is removed, usually together with the middle part (isthmus). It is preferred for one-sided benign nodules, indeterminate biopsy results and small, low-risk cancers.
• Total thyroidectomy: The whole gland is removed. It is performed for disease involving both lobes, large goitres and most thyroid cancers.
• Completion thyroidectomy: Removal of the remaining lobe when the pathology after lobectomy shows cancer.
• Neck dissection: Added to the thyroid operation when cancer has spread, or is suspected to have spread, to the lymph nodes.

The operation is performed under general anaesthesia through a horizontal incision placed in a skin crease at the lower neck. During the operation the voice nerve is monitored (nerve monitoring) and care is taken to preserve the parathyroid glands.

Preparation before surgery

Examination of the vocal cords, a check of thyroid hormone levels and blood tests are carried out. If the thyroid is overactive, it is brought under control with medication before the operation. It is important to tell your doctor about the medicines you take, particularly blood thinners.

The first days after surgery

Most patients go home the day after the operation or within a few days. What to expect:

• Mild pain and tightness in the neck, controlled with painkillers
• Slight discomfort on swallowing and a sore throat from the anaesthetic tube
• Temporary voice fatigue or slight hoarseness due to swelling around the vocal cords
• Numbness and swelling around the incision, which lessen over time

Possible risks

Serious problems are rare; even so, it is worth knowing about them:

• Hoarseness: Caused by injury to the voice nerve (recurrent laryngeal nerve); it is usually temporary and settles within weeks, and permanent hoarseness is rare.
• Low calcium: Particularly after total thyroidectomy, a temporary slowing of the parathyroid glands may cause tingling in the fingertips and around the lips or muscle cramps; this settles with calcium and vitamin D supplements and is rarely permanent.
• Bleeding and infection: Rare; a rapidly enlarging swelling in the neck or shortness of breath requires urgent assessment.

What should you pay attention to during recovery?

• Keep the incision clean and dry
• Avoid heavy lifting and movements that strain the neck in the first weeks
• Start with soft foods and return gradually to a normal diet
• The scar may be red and firm in the first months; protecting it from the sun helps it fade
• Return to daily life usually takes one to two weeks

The long term

When the whole gland is removed, thyroid hormone medication is taken for life and its dose is adjusted by blood tests. After lobectomy, the remaining lobe usually produces enough hormone; this is monitored with check-up tests. The pathology result usually comes back within a few weeks, and the next steps are planned accordingly.

When should you see a doctor?

In the event of a rapidly increasing swelling in the neck, shortness of breath, high fever, discharge from the incision, persistent tingling or muscle cramps, you should see a doctor without delay.