Surgery
In some cases, such as when a nodule is known to be quite small and localized, a hemi-thyroidectomy or partial thyroidectomy is performed. This keeps one side of the thyroid intact, allowing the body to continue to make thyroid hormone on its own. Partial thyroidectomies may also be preformed when FNAB results are inconclusive - that is, when it is not known for sure if the nodule is cancerous or not.
Sometimes a patient has a partial thyroidectomy, and following receipt of the pathology report (some weeks later), surgery is performed to remove the remaining part of the thyroid (completion thyroidectomy).
In the majority of cases, however, a total thyroidectomy is performed initially, which often includes dissecting (removing) adjacent lymph nodes for examination. A total thyroidectomy allows for a follow-up treatment of radioactive iodine if necessary. Lifelong monitoring for recurrence through Thyroglobulin (Tg) testing may also be done. (Thyroglobulin is the protein precursor of thyroid hormone and is made by normal well-differentiated benign thyroid cells or thyroid cancer cells. See "Understanding Your Blood Tests" section below).
Thyroid surgery requires skilled, experienced hands, as the thyroid gland is adjacent to the larynx (voice box) and important parathyroid glands. Results are better when surgery is done by a specialist trained and experienced in thyroid surgery. In some centres this may be a head and neck surgeon, in others a general surgeon.
Sometimes the tumour has grown outside of the thyroid (extra-capsular extension). Every effort must be made to keep intact the four small parathyroid glands which lie adjacent or attached to the thyroid. If the tumour surrounds the parathyroid gland(s), they may need to be removed. In some cases, the surgeon moves one or more of the parathyroid glands and attaches them to adjacent muscle tissue. It is very important that at least one parathyroid gland is in 'working order' after the surgery, as the glands have the vital function of controlling calcium levels in the body.
Sometimes the surgery requires more extensive intervention as the cancer may have metastasized to several lymph nodes in the neck or upper chest. When a number of lymph nodes are removed the procedure is known as a neck dissection.
Patient recovery from a total thyroidectomy is usually relatively easy. You will probably stay in hospital for one or two nights. Initially a drainage tube may be left in at the surgical site, and it is usually removed before discharge from the hospital. Nurses and doctors will check frequently that the parathyroid glands are functioning, by tapping your cheeks and asking about numbness in fingers and toes. A blood test for calcium (i.e. for parathyroid functioning) is done prior to discharge.
Some patients may experience a stiff neck, sore throat or a weak voice upon waking-up from surgery. These are temporary conditions caused primarily by the position the patient was in for surgery and by the intubation tube, used to support breathing during surgery. Patients who have more involved surgeries, such as a neck dissection, may experience more stiffness and discomfort and have a longer recovery period. Discuss your pain management needs and options with your doctor prior to surgery.
Making Your Hospital Stay Comfortable
Here are some suggestions to make your hospital stay more comfortable:
- Prepare. Take the time to prepare your home for your return after surgery. Stock up on easy-to-prepare foods and have a few comfort foods that are soothing to the throat (ice cream, yogurt, soup, apple sauce, puddings and juice).
- Find a driver. Make arrangements in advance to have someone drive you to and from the hospital. The Canadian Cancer Society is also available to help in this regard.
- Lighten your workload. You will need recovery time after surgery. If you have children, make arrangements for help. If you have a dog, ask someone to do the walking for a few days. Heavy lifting should be avoided until you've healed.
- Having hot and cold packs to ease sore muscles and swelling may be helpful.
- Use a 'dog bone' shaped neck pillow. This curved pillow may be comfortable to support your neck after surgery (available from spa supply stores, travel accessories supply stores, drug stores and health supply stores. Free downloadable patterns also available on the internet.) A soft pillow pushed into this shape will also work.
- Pack for the hospital stay. Remember to bring:
- any medications you take on a daily basis
- your own soft pillow or dog bone pillow
- toiletries (toothbrush, toothpaste, moisturizer)
- slip-on slippers
- robe and sleepwear, if you do not want to use the hospital gowns. Pyjamas or nightgowns must have button fronts or be able to be slipped on from the feet up, in order for the IV line to thread properly up the sleeve.
- easy reading material like a magazine or paperback, as your concentration will not be good (take copies you can lose or leave behind).
- After release from hospital...
- Don't lose the notes given to you by the doctor - they contain prescriptions, instructions for symptoms to report, and instructions to your family doctor for tests and follow-up.
- Keep records on the medications you take, calcium intake, symptoms, etc. until your post-surgery appointment.
- Eat soft high-fibre foods such as stewed prunes or use a gentle laxative to recover from constipation if it is present.
- Try not to develop the habit of hunching your shoulders. This 'splinting' feels better temporarily, but after a few days the upper back may become sore. Gentle massage and hot packs will help ease this tension pain.
- Minimize your scar. Follow your doctor's directions for keeping your incision covered (i.e. with steri-strips, gauze and antibiotic ointment). Your doctor will evaluate the healing of your scar when your stitches are removed and advise you of any other steps to help minimize your scar.
- Rest. Recovery usually takes several weeks.
Possible Complications
Complications from thyroid surgery are generally rare but can happen. Complications of a thyroidectomy include the potential problems associated with any operation and the possible change in voice due to injury to one of the laryngeal nerves beside the thyroid. The likelihood of a permanent injury to the nerve is approximately 1%. If this complication occurs, the voice box often adjusts, resulting in gradual improvement in voice quality over time.
In some cases there is damage to one or more of the four of the parathyroid glands. The parathyroids are 4 tiny rice-sized glands located adjacent to the thyroid that control the blood calcium level. Following a total thyroidectomy, approximately 30% of patients will have temporary injury to these glands, resulting in a drop in blood calcium level, called hypocalcemia. The symptoms of hypocalcemia may include tingling in the finger, toes and around the mouth. Very low calcium levels can also produce muscle cramps or spasms or shortness of breath. If you experience any of these symptoms following a thyroidectomy, you should immediately contact your physician or go to the emergency room. Approximately 2% of patients have permanently low calcium following a total thyroidectomy, even when careful steps are taken to preserve and protect the parathyroids during surgery. Hypocalcemia (low calcium) is treated with calcium supplements and a high-dose vitamin D available by prescription.
Disclaimer: The information contained on this website does not constitute medical advice. Visitors are encouraged to work closely with their doctors to make sure that their individual medical needs are met. The Canadian Thyroid Cancer Support Group (Thry'vors) Inc. does not endorse any product, treatment, service or practitioner and is not responsible for the quality of the information or services offered by other organizations or websites.
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