What should I expect the day of surgery? 

You will be required to eat and drink nothing after midnight.  The morning of surgery, you will arrive at the surgery center or hospital and change into a gown.  An IV will be started, and standard safety questions will be asked, including confirmation of the side of the procedure. 

You will meet with the anesthesiologist, who will take a history from you.  You will meet with Dr. Wright again, and the operative plan will be reviewed.  Any remaining questions you have will be answered. 

You will then be taken to the operating room, where you will drift off to sleep under general anesthesia.  When the procedure is complete, you will be taken to the recovery room, where your heart and breathing will be monitored and any pain will be controlled. 

After about an hour, you will be allowed to visit with your family.  For partial thyroid surgery, you will most likely be able to go home; for total thyroidectomy, you will then go to the hospital surgical ward for overnight monitoring.

Is recovery from thyroid surgery painful? 

Minimally invasive surgery techniques allow for the removal of the thyroid gland through smaller incisions and the avoidance of dividing muscles.  This results in a much less painful recovery than traditional techniques. Combined with the liberal injection of lidocaine (a local numbing agent), immediate post-operative pain is generally quite low.

Can I eat after surgery? 

There is no restriction on eating after surgery.  During the immediate recovery phase, simple juices and crackers are offered until it is clear whether a patient may have nausea.  Later on, there is no restriction.

Are there lifting restrictions after thyroid surgery? 

Within the first three to five days, Dr. Wright prefers patients to avoid lifting more than 20 pounds.  After one week, moderate lifting is allowed.  After two weeks, there is no restriction whatsoever.  These guidelines can vary depends on the details of the surgical scenario.

Will I need thyroid hormone replacement after surgery? 

When the thyroid gland cannot make adequate thyroid hormone, patients require a pill to replace the hormone normally made by the thyroid gland.  For patients undergoing total thyroidectomy, lifetime thyroid hormone replacement with a once-daily hormone pill (levothyroxine, Synthroid) is required. 

For patients undergoing partial thyroid surgery who previously did not require a thyroid pill, there is a one in four (75%) chance that the remaining thyroid gland will produce enough hormone to meet the needs of the body.  Patients undergoing thyroid surgery will undergo a blood test a few weeks after surgery to assess the thyroid function levels.

Will I gain weight if I have my thyroid removed? 

No.  As long as thyroid hormone levels are maintained (either naturally or with supplementation), there is no physiologic reason for patients to gain weight.  Our experience has been that patients maintain their baseline weights throughout the treatment process.  Obviously, maintaining a healthy balance of diet and activity will be just as important after thyroid surgery as before.

Who will manage my thyroid hormone levels after surgery? 

Most primary care doctors are skilled at monitoring thyroid hormone levels after surgery.  If a patient has a thyroid cancer, an endocrinologist will frequently take charge of thyroid hormone management and cancer monitoring.

When will I know if my thyroid nodule has cancer? 

Determining whether or not a thyroid nodule is cancer can be very complicated and may take several days.  In some cases, a cancer can be identified within one to two days. In many cases, however, sophisticated laboratory tests on the tissue have to be performed.  These can be time-consuming and reflect the complexity of thyroid cancer, which frequently looks very similar to normal thyroid tissue. 

Because important treatment decisions hinge on this information, pathologists have to be certain before issuing a diagnosis of cancer.  Our thyroid team makes a special point to contact our patients as soon as possible when we get these results.

How will I know if cancer has spread? 

When surgery is performed for cancer, a sampling of lymph nodes is usually performed.  This will help determine the stage of the cancer and provide information regarding the likelihood of lymph node spread. 

Many studies have assessed whether comprehensive removal of lymph nodes reduces recurrence or death rates from thyroid cancer.  There is general agreement that extensive lymph node resection in patients without bulky pre-existing lymph node spread is not necessary.  If lymph node involvement is discovered on final pathology, it is likely that post-operative radioactive iodine treatment will be recommended.

What is radioactive iodine? 

The main building block of thyroid hormone is iodine; no other cell type absorbs iodine as strongly as does the thyroid gland.  Radioactive iodine (RAI) is a form of iodine which has been modified to be radioactive. 

Even after total thyroidectomy, small clusters of thyroid tissue may be present—embedded in ligaments near the trachea, near the recurrent laryngeal nerve or in lymph nodes.  These nests of thyroid tissue can retain cancer or represent metastasis (spread). 

These scattered areas of thyroid material can be destroyed with radioactive iodine (RAI). Once in the bloodstream, the RAI is absorbed by and concentrated in these cell clusters, where the radiation destroys the thyroid cells.  Not only does this accomplish tumor eradication, it also facilitates long-term monitoring for potential recurrence.  RAI is typically administered about six weeks after surgery.

Why can’t RAI replace the need for surgery? 

RAI only works on very small amounts of thyroid tissue.  The radiation dose for an entire thyroid gland would be dangerous and likely not target cancer adequately to lead to a cure.  Most of the radiation would go into the healthy portion of the gland and bypass the small areas of cancer spread.

How dangerous is thyroid cancer? 

The vast majority of thyroid cancers are not aggressive and can be cured by surgery +/- RAI.  Uncommonly, a papillary or follicular thyroid cancer will behave aggressively and recur or spread.  Long-term monitoring – cancer surveillance – is critical to screen for any recurrence so that it can be addressed early.  With proper surgery, post-operative management and surveillance, cure rates for Well Differentiated Thyroid Cancer are excellent .

How will long-term cancer surveillance be performed? 

Several methods of assessing recurrent thyroid cancer are utilized. The first is a blood test which measures a protein called thyroglobulin, which is only made by thyroid cells. 

Following initial cancer treatment, we expect this level to be nearly zero.  This is a very reliable indicator for the presence of thyroid tissue in the body, so if we see this level creep up or spike, we know that further investigation must be carried out to find the area of recurrence. 

When recurrence is suspected, sophisticated imaging studies or scans can be carried out to localize the tumor recurrence.  Ultrasound is commonly used during the surveillance period. 

If I have one-half of my thyroid gland removed, will I need to take a thyroid hormone replacement pill? 

Studies show that roughly 75% of patients undergoing partial thyroidectomy will not require hormone replacement long term.  Several factors may predict whether or not an individual will need replacement, the most important of which is the presence of Hashimoto’s thyroiditis. This is a chronic inflammatory condition of the thyroid gland that usually eventually results in hypothyroidism and hormone replacement.  If you have Hashimoto’s thyroiditis, you will likely someday require a thyroid pill.