Thyroidectomy Overview: What to Expect from Surgery

If your healthcare provider has discussed a thyroidectomy as a potential next step in your treatment plan, you might be wondering what it entails and how it will affect your life afterward. Simply put, it's surgery to remove all or part of your thyroid gland, which greatly regulates your metabolism and energy. Whether it's needed due to thyroid cancer, an overactive thyroid, or another issue, here's everything you need to know about what to expect before, during, and after the procedure.

What is a Thyroidectomy?  

Thyroidectomy is a surgical procedure in which the surgeon removes all or part of your thyroid gland. The normal thyroid gland is a butterfly-shaped gland in the neck that releases thyroid hormones. Thyroid hormones control many important bodily functions, including metabolism, growth and development, body temperature, heart rate, and digestion. Both too little and too much thyroid hormone can cause problems. 

Total vs. Partial Thyroidectomy  

Some patients undergoing thyroidectomy need only part of the thyroid gland removed. This is called a partial thyroidectomy or thyroid lobectomy. The remaining thyroid gland may continue to work normally after surgery.

In some cases, the entire thyroid gland needs to be surgically removed. This is called a total thyroidectomy. Patients undergoing total thyroidectomy need lifelong thyroid hormone replacement (daily medication to replace the thyroid’s natural function).

Common Reasons for Thyroid Removal  

Surgeons perform a thyroidectomy to treat both malignant and benign thyroid disease. Some of the thyroid disorders commonly treated with surgical removal include:

• Thyroid nodules are a type of abnormal thyroid growth. They are usually benign (non-cancerous) but sometimes malignant (cancerous). Thyroid nodules may produce excess thyroid hormone and cause symptoms of hyperthyroidism (overactive thyroid gland).

• Goiter, which is an enlarged thyroid gland. It may or may not contain thyroid nodules. If a goiter becomes large enough, it can put pressure on surrounding organs such as the trachea (windpipe) and esophagus (food pipe), making breathing and swallowing difficult.

• Hyperthyroidism or overactive thyroid gland. This can occur due to several causes, such as autoimmune thyroiditis, toxic multinodular goiter, uncontrolled Graves’ disease, or thyroid adenomas (benign tumors that secrete thyroid hormone). If medications or radioactive iodine therapy are not an option, your doctor may recommend thyroidectomy surgery for hyperthyroidism.

• Thyroid cancer is a type of cancer that starts in the thyroid gland. There are various thyroid cancers, including papillary thyroid, follicular carcinoma, medullary thyroid, anaplastic thyroid, and primary thyroid lymphoma. 

• Metastatic disease is the spread of cancers in other body parts to the thyroid. Renal cell carcinoma (kidney cancer) and lung cancer commonly spread to the thyroid.

Thyroidectomy Procedure  

Before Thyroidectomy Surgery

Before a thyroidectomy, your doctor will evaluate your thyroid function with blood tests to determine whether you have hyperthyroidism (an overactive thyroid) or hypothyroidism (an underactive thyroid). The results of this testing will influence your medical management before, during, and after your surgery. 

The initial imaging test that is typically done is a thyroid ultrasound. This test uses sound waves to create images of the thyroid gland. Other imaging tests may include a CT (computed tomography) scan or MRI (magnetic resonance imaging) scan. These tests help doctors identify structural abnormalities in your thyroid gland, such as suspicious nodules. You will also likely undergo an examination with an instrument called a laryngoscope to assess vocal cord function.

In addition, you will undergo a pre-surgical evaluation that includes blood tests, a chest X-ray, an EKG (electrocardiogram), and other tests.

If any lesions or abnormalities are seen in your thyroid gland, your doctor may do a fine-needle aspiration biopsy to obtain a sample of thyroid tissue for evaluation in the laboratory. This allows your doctor to identify a malignancy vs benign thyroid disease. The decision to perform a thyroid lobectomy versus a total thyroidectomy depends on various factors, including the size, location, and features of thyroid cells as seen under a microscope.  

Preparing for Thyroidectomy Surgery

Your surgical team may give you an antibiotic before your thyroidectomy to prevent infection. You may also receive medication to reduce nausea and vomiting related to surgery. If you have hypothyroidism or hyperthyroidism, your doctors will give you medicines to keep your thyroid hormones in balance before and after you undergo surgery.

Your thyroid medicine team will give you specific instructions to stop eating, drinking, and taking medications before your surgery. Follow these instructions carefully. You need to have an empty stomach before any surgical procedure using anesthesia.

What Happens During Thyroid Surgery?  

Most thyroidectomies are performed under general anesthesia. This means you will be asleep during the surgery and will not experience pain. 

For a conventional thyroidectomy, you will be placed in a semi-seated position. Your chin will be tilted back, and your neck and shoulders will be supported.

Your surgeon will make a small incision (cut) in the skin of your neck. They will try to do this in a natural skin crease to make the scar less visible. Following this, the surgeon will separate a thin layer of neck muscle and access the thyroid gland. They will remove a thyroid lobe or the entire thyroid gland and any nearby lymph nodes that may be diseased. Afterward, the surgeon will close the muscle and skin with staples or glue. 

A newer method of surgical removal of the thyroid is called a scarless transoral thyroidectomy. In this procedure, the surgeon accesses your thyroid gland through your mouth. There is no incision outside the neck and no visible scar after the surgery.

Duration and Expected Outcomes  

A thyroidectomy typically takes 1 to 2 hours to complete. However, the duration of the surgery depends on the reason for the procedure. For example, if you're having a thyroidectomy for thyroid cancer, your surgeon will also explore and remove lymph nodes surrounding your thyroid. Sometimes, surgeons use special equipment for intraoperative nerve monitoring of the vocal cords to prevent permanent damage. Explore more thyroid cancer treatment options.

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Post-Operative Care and Potential Risks

Is Thyroidectomy a Major Surgery?

Yes, thyroidectomy is considered a major surgery. However, it is generally safe, provided you follow your healthcare team’s instructions. 

How Long is Recovery From Thyroid Surgery?

Hospital discharge: Some patients have an outpatient thyroidectomy and go home the same day, while others may need to spend a night in the hospital.

Recovery period: Most people take about 2 weeks off work to recover from thyroid surgery.

What Happens When You Get Your Thyroid Removed?

Side effects of thyroidectomy or thyroid lobectomy: You may have neck pain, sore throat, difficulty swallowing, and a weak voice for a few days after your procedure. 

Diet: Your surgeon may give you dietary restrictions for 1-2 days, such as eating only soft foods.

Precautions:

• Avoid heavy lifting or straining your neck for 3-4 weeks. 

• Do not soak or scrub the incision for 1-2 weeks.

• Showering is usually allowed after 1 day.

Followup: Before you leave the hospital, your healthcare team will schedule a follow-up appointment. Keep all medical and laboratory appointments, follow at-home recovery instructions carefully, and take the prescribed medications.

Potential Risks and Complications of Thyroidectomy

Thyroidectomy is a major surgery, and while it is generally safe, there are certain risks. Potential complications from thyroidectomy include:

• Bleeding.

• Infection.

• Permanent hoarseness or a weak voice due to recurrent laryngeal nerve injury (damage to nerves in the vocal cords).

• Damage to the parathyroid glands can lead to hypoparathyroidism or a low parathyroid hormone (PTH) level. The PTH hormone regulates blood calcium levels, and low blood calcium (hypocalcemia) can cause symptoms such as numbness, tingling, or muscle cramping.

Managing Postsurgical Pain and Discomfort  

Pain after thyroidectomy at the site of the incision is usually temporary. It typically lasts for a few days to one week. Your doctor may recommend taking over-the-counter pain medication or a prescription pain pill to manage any post-surgical neck pain.

When to Call Your Surgeon

Call your thyroid surgeon if you notice any redness, swelling, or increasing pain at the incision site or neck. These can be signs of infection.

Also, call your doctor if you develop numbness and tingling in your fingers or around your mouth. This may be due to low calcium levels caused by damage to the parathyroid glands. If necessary, your doctor may prescribe oral calcium supplementation.

Life After Thyroid Removal  

Can You Live Without a Thyroid? 

Yes, you can live without a thyroid. However, as mentioned, the thyroid gland is responsible for many important body functions. Therefore, people who undergo a total thyroidectomy need lifelong thyroid hormone replacement therapy. This therapy includes taking daily medication, making healthy lifestyle choices, and undergoing periodic testing and medical follow-ups.

Impact on Thyroid Hormone Levels

After a total thyroidectomy, where the entire thyroid gland is removed, you develop hypothyroidism (low thyroid hormone levels). As a result, you need lifelong thyroid hormone replacement therapy, for example, with levothyroxine (Synthroid). This is necessary to maintain normal thyroid hormone levels and prevent mood changes and other symptoms of hypothyroidism.

How Does Thyroidectomy Affect Overall Health and Well-Being? 

Thyroidectomy is generally safe, and most people recover fully. However, as mentioned above, specific risks associated with the procedure exist, including bleeding, infection, recurrent laryngeal nerve paralysis, and hypoparathyroidism with severe symptomatic hypocalcemia (low calcium). These surgical complications can result in ongoing medical care and a reduced quality of life in some patients. Following your endocrine surgeon's guidelines can help lower your risk of complications and long-term health problems.

Recovery and Lifestyle Adjustments

Importance of Regular Blood Tests and Monitoring  

If your whole thyroid gland has been removed, you will need to take thyroid hormone replacement (levothyroxine) for life. Regular blood tests are necessary to ensure the correct dose. Your primary care provider or thyroid medicine team can order these tests.

Dietary Considerations and Foods to Avoid 

Foods to Eat After Thyroidectomy

It’s important to eat a healthy, well-balanced diet after thyroidectomy. This will support the healing process by providing the necessary nutrients for tissue repair. It will also help to maintain a healthy body weight after surgical removal of the thyroid (the thyroid gland regulates metabolism). 

Foods to eat after thyroid surgery include lean proteins, whole grains, fruits and vegetables, low-fat dairy, and healthy fats. It’s also important to stay well hydrated by drinking plenty of water.

Foods to Avoid After Thyroidectomy

Iodine-rich foods (seaweed, iodized salt, medications, or supplements that contain iodine) because excessive iodine can interfere with thyroid function.

During initial recovery from thyroid surgery, your doctor may recommend avoiding hard foods such as raw vegetables or nuts and seeds, which can irritate or cause discomfort in the throat.

Other than this, no specific dietary restrictions exist for patients undergoing thyroidectomy. You should follow general healthy dietary recommendations, such as avoiding sugary, salty, fatty, and processed foods.

What Are the Do’s and Don’ts After Surgery?  

You can gradually increase your activity levels and return to normal life after thyroid surgery: 

• First Week: Avoid heavy lifting. Focus on recovery. Start moving by walking short distances at home. 

• Weeks 2-4: You’ll start to feel more like yourself with decreased pain and discomfort. Slowly increase your activity level, but avoid strenuous exercises.

• Weeks 4-6: You can resume most normal activities. Your energy levels should have improved, and you should be able to exercise at pre-surgical levels. However, continue avoiding heavy weightlifting and high-impact exercises.

• Week 6 and beyond: You can likely return to your pre-surgery activity level after your surgeon clears you.