When you have hypothyroidism, your thyroid gland doesn’t produce enough hormone. The most common cause of hypothyroidism is Hashimoto’s thyroiditis. In this condition, the body’s immune system mistakes the thyroid gland for something it needs to attack. Hypothyroidism may also occur if there’s not enough iodine available for the thyroid to make hormone, if there are problems with the pituitary gland, or if the thyroid gland is removed.
With hyperthyroidism, the thyroid gland produces too much hormone. The most common cause of hyperthyroidism is Graves’ disease, a problem where the body’s immune system overstimulates the thyroid. Graves’ disease sometimes causes the eyes to look like they’re bulging (exophthalmos). A nodule in your thyroid gland can cause hyperthyroidism if the cells in the nodule produce more hormone than the rest of the gland.
Nodules are lumps of tissue in the thyroid gland. Usually, the cause of nodules isn’t known, but they may be more common in people who’ve had therapeutic radiation to the head or neck. Most of the time, nodules don’t affect the production of thyroid hormone and cause no symptoms. Sometimes they can be felt on the outside. Most nodules are benign (noncancerous), but occasionally a nodule may be cancerous.
A goiter is the enlargement of the thyroid gland. When the gland enlarges, you may see or feel a swelling on your neck. A goiter may develop in a person with hypothyroidism.
Surgery can be done to remove a very large goiter or nodule, a hyperthyroid gland that can’t be controlled with medications, or a thyroid gland that may be cancerous.
Ask your surgeon whether you need to stop taking aspirin, other medications, supplements, or herbal remedies before your procedure. Unless instructed otherwise, don’t eat or drink anything for 12 hours before the procedure. You’ll probably be admitted to the hospital or surgery center on the day of surgery. You usually need to be monitored after surgery, so prepare to spend one or more days in the hospital.
During the procedure, an intravenous (IV) line provides you with fluids and medications. You’ll be given general anesthesia, so you’ll be asleep during the procedure. An incision is made in your neck, along a crease in your skin. The surgeon may remove one half of the thyroid gland (lobectomy), most of the gland (subtotal thyroidectomy), or the entire gland (total thyroidectomy). Sometimes, the decision about how much of the thyroid to remove can’t be made until the surgeon makes the incision and can see the area around the thyroid. Once the procedure is completed, the incision is closed with surgical strips, surgical clips, or sutures. Occasionally, a drain may be left in the incision to remove fluid that can build up.
You can usually begin to eat and drink normally the evening after the procedure, but you may still be a little queasy from the anesthesia. Once the anesthesia has worn off and you’re feeling up to it, you’ll be able to get up and walk around. You may be given oral medication for pain the first day or so, but discomfort is usually minimal. A sore throat and hoarseness are common and may last for a week or so after surgery. During your hospital stay, you’ll be monitored for bleeding and to make sure your parathyroid glands are working normally. The stress of surgery may stun these glands for a short time, so you may be given calcium supplements for a few days.
Activity: You will be discharged the day after your surgery. You may be up and around as you desire, but should avoid overly strenuous activity for several days. You may walk and climb stairs. You may resume normal activities after the first week. You may drive once you are off pain medication and are able to move and turn your neck easily.
Care for the incision: The original dressing will usually be removed before you are discharged. Leave the white steri-strips on the incision until your follow up visit. The steri-strips may get wet.
Diet: For the first 24 hours after surgery, you may not have much of an appetite or feel able to tolerate heavy foods. We encourage you to begin with a soft diet and to keep up with your liquids. As your appetite increases, and you are not having difficulty swallowing, you will find yourself eating normally. There are no restrictions- just eat what your system can tolerate.
Medication: You may be given a prescription for pain medication. Take this as directed for post-operative pain. If you are experiencing only mild discomfort, you may find over-the-counter medications, such as Tylenol (acetaminophen) or Advil/Nuprin (Ibuprofen), may be all you need for comfort.
You may be given a prescription for or asked to take calcium. Please follow your instructions carefully; your calcium levels may be monitored, depending on the extent of your surgery.
What to look for: You may notice some swelling or slight drainage (usually pink or reddish in color) or bruising around the incision. This is normal and not cause for concern. However, please call our office immediately if you develop any of the following: difficulty breathing, tingling in your hands or face, difficulty speaking, difficulty swallowing, excessive drainage or bruising, redness or swelling around the incision, fever over 100?F, or persistent nausea or vomiting.
Follow-up: You may need your calcium level measured. If so instructed, please have this test done through your Primary Care Physician’s office, or at a lab specified by your insurance company. The test results should be faxed to us immediately at (703) 591-6105.
You will be seen in our office 7 to 10 days after your surgery and again in several weeks. Prior to surgery, you should have made an appointment for your first post-operative visit. If for some reason that appointment was not scheduled, please call our office at (703) 359-8640 as soon as your return home to schedule your appointment.
Post-op Appointment: Please call our office at 703-359-8640 to schedule a post-op appointment with your physician.
Difficulties: Please call us if any problems or questions arise. We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640.
After you’re feeling better, the right care can keep you feeling good. If you’ve been given thyroid hormone or other medications, take your pills regularly to help keep your thyroid hormone at the right levels and your body running smoothly. See your doctor as directed for regular blood tests. These tests confirm that your hormone pills or medications are still at a dose that’s right for you. If you’ve had treatment for cancer, regular exams help catch it early if it returns. No matter what the cause, thyroid problems don’t have to keep you from feeling good and doing what you like.