What Will Be My Physical Restrictions Following Surgery
Most surgeons prefer that patients limit extreme physical activities following surgery for a few days or weeks. This is primarily to reduce the risk of a postoperative neck hematoma and breaking of stitches in the wound closure. These limitations are brief, usually followed by a quick transition back to unrestricted activity. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days to 2 weeks.
History Of The Surgical Procedure
Around 2700 BC, goitre was appreciated in China, and in as early as 1600 BC, the Chinese used burnt sponge and seaweed to treat goitres. Pliny the Elder noted goitre epidemics in the Alps and also mentioned the use of burnt seaweed in their treatment which supposedly they learnt from the Chinese. The Artharva Veda , an ancient Hindu collection of incantations, also contains exorcisms for goitre. It termed the swelling of the neck as galaganda.
The earliest anatomical picture of the thyroid gland was made by Leonardo da Vinci in 1511 during his anatomical studies in Florence. The exact function of the gland was not known to him, and he presumed that its purpose was to fill in the interval produced by a deficit of muscles, in so doing holding the trachea away from the sternum .
Exophthalmic goitre was first described by Caleb Hiltier Parry of Bath in 1768 in his write-up in Enlargement of the Thyroid Gland in Connection with Enlargement or Palpitation of the Heart . This subject was then further scrutinised by Robert James Graves and Carl Adolf von Basedow who published their observations independently in 1835 and 1840, respectively. Their publications dealt with the association of goitre, exophthalmos, palpitation, irritability, weight loss, wild hunger, hyperactivity, warmth and sweating .
Should I See Dr Mourad About My Thyroid Surgery
Dr. Mourad is an expert in the area of thyroid surgery and is one of New York Citys highest volume thyroid surgeons. He routinely performs more than 50 thyroid surgeries every year, in addition to having published leading scientific works on thyroid surgery and thyroid cancer. He is also a leading expert in the field, pioneering new research harvesting the power of artificial intelligence to help manage patients with thyroid cancer. His research was recently presented at the International Federation of Head and Neck Surgery 6th World Congress in Argentina.
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Will I Need To Take A Thyroid Pill After My Operation
The answer to this depends on how much of the thyroid gland is removed. If half thyroidectomy is performed, there is an 80% chance you will not require a thyroid pill UNLESS you are already on thyroid medication for low thyroid hormone levels or have evidence that your thyroid function is on the lower side in your thyroid blood tests. If you have your entire gland removed or if you have had prior thyroid surgery and now are facing removal of the remaining thyroid then you have no internal source of thyroid hormone remaining and you will definitely need lifelong thyroid hormone replacement.
Anatomy Of The Parathyroid Glands
The parathyroid glands develop from the third and fourth pharyngeal pouches. The inferior parathyroid glands develop from the third pouch and descend at week 7 with the thymus to eventually rest at the dorsal surface of the thyroid gland outside of the thyroid capsule. The superior parathyroids develop from the fourth pouch and descend with the thyroid gland. The superior parathyroid glands are usually posterior to the inferior glands, and, as noted in the figure, they usually lie posterior to the plane of the recurrent laryngeal nerve.
Accessory parathyroid glands, as noted by Munck and Eisele, occur 3-7% and fewer than 4 glands are present in 3-6% of patients. Gland descent is usually symmetric, and contralateral glands are usually located at the same level. Aberrant or ectopic glands can also be present if the glands descend incompletely or too far. Possible locations for parathyroid glands include the anterior or posterior mediastinum, carotid bifurcation, as well as the retroesophageal, retropharyngeal, or retrolaryngeal regions. The vascular supply for the parathyroid glands is usually from the inferior thyroid artery, although occasionally the superior glands are supplied by an anastomosis between the inferior and superior parathyroid arteries.
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When To Notify Our Office
You should call our office at 410-328-6187 if you experience the following symptoms:
- Fever with a temperature higher than 101.5.
- Difficulty swallowing
- Increase in pain at the incision that is not relieved by pain medication
- Increased swelling, redness, or drainage from the incision
- Numbness or tingling of fingers, toes, or around the mouth.
Hoarseness And Voice Problems
After surgery, your voice may be hoarse or whispery, and it may feel tiring to talk. This is very common and expected during the first week or two after surgery. While around 1% of people may have damage to the nerves supplying the vocal cords, around 5% to 10% of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward.
Symptoms usually improve in the first few weeks but may persist up to six months after surgery. While there is no specific treatment for this hoarseness, it’s helpful for your loved ones to be aware of the problem so that you don’t feel the need to talk loudly or more often than is comfortable. If the nerve was injured, more severe symptoms may be noted after surgery.
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Surgery For Eyelid Retraction
TED can cause muscles and fatty tissue behind your eye to swell. This can push your eye out of position.
In some cases, your eyelid is no longer able to cover the whole eye. When your eyelid cant close all the way, the exposed part of your eye becomes very irritated.
This surgery adjusts the position of your eyelid.
How To Maintain Healthy Hormone Levels After A Thyroid Lobectomy
Patients who undergo thyroid lobectomy have a distinct advantage over those who undergo a total thyroidectomy . Thyroid lobectomy patients still have part of their thyroid, so they may not need supplemental thyroid medication like levothyroxine.
They also have a lower risk of complications like hypoparathyroidism and hypocalcemia .
But, with only 50% of a functioning thyroid gland, these complications are still possible. Other more subtle side effects include possible weight gain, increased risk of osteoporosis, and hypothyroidism , which may show up as fatigue, feeling cold, constipation, muscle weakness, and weight gain, among other symptoms .
Whether youre taking supplemental thyroid hormones or not, supporting your thyroid after surgery looks like:
- Prioritizing key nutrients that support thyroid health
- Improving and supporting gut health
- Making sure to get plenty of rest and take time to destress each day
- Follow up with your endocrinologist for regular lab testing to check on your thyroid hormone levels .
Key nutrients are the same ones we mentioned earlier for natural thyroid support: vitamin D, calcium, selenium, and magnesium, among others. You should make sure to eat foods that carry these nutrients regularly, but you can also work with a healthcare provider to determine which ones you may need to supplement.
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My Calcium Levels Will Drop
Adjacent to your thyroid gland are four small but vital glands called the , which produce a hormone that regulates calcium levels in the blood. After a thyroidectomy, some people experience symptoms of low calcium such as burning, tingling, or numbness in their hands, feet, or around the mouth. According to Dr. Agarwal, this can be due to an interruption in the blood supply to the parathyroid glands or the inadvertent removal of the parathyroids during surgery.
People who undergo thyroidectomy to treat an autoimmune thyroid disorder, such as or , are at heightened risk of this side effect, as are those with extensive and advanced thyroid cancer, says Dr. Agrawal.
Fortunately, the disruption in calcium levels can usually be remedied in one to three months by taking daily supplements of calcium and/or vitamin D , says Maria Evasovich Swenson, MD, a surgical oncologist at the University of Minnesota Medical School and M Health Fairview.
Once the parathyroid glands recover and parathyroid hormone levels return to normal, the supplements can be stopped. However, you may require lifelong supplementation if damage to your parathyroid is permanent, which occurs in fewer than 5% of cases.
What Are The Types Of Thyroidectomies
There are two main categories of thyroidectomies: Total and partial.
Types of partial thyroidectomies, which involve removal of part of your thyroid include:
- Hemi-thyroidectomy or thyroid lobectomy: The surgeon removes one lobe of your thyroid.
- Isthmusectomy: The surgeon removes the thyroid tissue between the two lobes . Surgeons perform this surgery specifically for small tumors that are located in the isthmus.
- Open thyroid biopsy: In this operation, the surgeon removes a thyroid nodule directly. Surgeons rarely perform this surgery.
A total or near-total thyroidectomy is the surgical removal of all or most of your thyroid tissue.
The type of thyroidectomy you need depends on the reason for the surgery. For example, if you have a nodule on one side of your thyroid, you may need a hemithyroidectomy to remove the affected lobe. If you have a large goiter or a large cancerous tumor, youll likely need a total thyroidectomy.
Together, you, your endocrinologist and your surgeon will determine the best surgery plan for you.
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Your Thyroid In A Nutshell
Your thyroid gland produces hormones that have a direct effect on your:
People with thyroid problems can experience symptoms like:
- Feeling unusually cold or hot
- Dry, itchy skin
- Unexplained weight gain or weight loss
- Anxiety and nervousness
- Digestive problems or changes in bowel habits
The symptoms you have will depend on whether your thyroid gland produces too many hormones or too few . Often, these common thyroid problems can be treated with medicine.
Many thyroid problems can be diagnosed or detected using a blood test. Your doctor will also review your symptoms, which might include:
- A lump near the base of your neck
- Problems swallowing
- Throat or neck pain
- Swollen lymph nodes
Some problems, like nodules, may not cause any noticeable symptoms until they grow large enough to be felt. In that case, youll have to pay close attention to the other symptoms listed above.
Other Considerations: Parathyroid Autoimplantation
In the event of accidental avulsion of a parathyroid gland or compromising its blood supply, the effected parathyroid gland should be removed and placed within a specimen cup on ice. A portion of the removed tissue should be sent for frozen section to confirm it to be in fact parathyroid tissue. The surgeon should then consider auto-implantation of the gland.
The parathyroid gland specimen should be minced into small 1-2 mm pieces and placed in a muscular pocket. Auto-implantation is described in the forearm or the sternocleidomastoid muscle. When implanting into the sternocleidomastoid muscle, a small pocket should be made within the muscle fibers. A nonabsorbable radio-opaque marker, such as a surgical clip, can be used to identify this location in the event of future surgical intervention.
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Are There Related Procedures To Thyroid Surgery
Thyroid surgery may involve other procedures depending on the indication for your surgery. If you are undergoing thyroid surgery for cancer removal, your surgeon may also address other parts of your neck, to remove all disease. The surgeon may perform what is called a neck dissection that involves removing neck lymph nodes that may have the disease. Patients that also have a history of thyroid cancer may also need to have Radioactive Iodine Ablation after surgery. This involves administering radiation therapy to remove any residual cancer cells in the body.
How Does Thyroid Removal Affect Your Body
If you have all or most of your thyroid removed, your body can no longer make enough thyroid hormone. Thyroid hormone is essential for life and plays a role in most of the bodys system functions. So if you no longer have enough, your provider will recommend medication. This helps replace your natural thyroid hormone.
Without thyroid hormone replacement, you’ll develop symptoms of hypothyroidism . These symptoms can include:
These symptoms usually go away when you take thyroid hormone replacement.
If untreated, hypothyroidism can become life-threatening. That’s why your provider will order blood tests to check your thyroid hormone levels soon after surgery and then regularly after. This is to make sure your hormone levels stay in a healthy range and youre taking the correct dose of medication.
If you only had a small portion of your thyroid removed, theres an 80% chance you won’t need thyroid medication.
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What To Expect After The Procedure
After the operation is finished, the pulse, blood pressure and other vital signs will be monitored for a while. There may be a tube in the neck to drain fluid. This will probably be removed the next day.
You may be drowsy after the anaesthetic and take a few days to recover. Your voice may be hoarse or weak and you may have some pain in your neck. These symptoms normally go away quickly.
You will probably be able to go home the same day or the next day. However, dont do anything strenuous for 10 days after the surgery.
Removing The Thyroid Gland
After identifying and stimulating the recurrent laryngeal nerve, the thyroid gland can be removed. Berrys ligament defines the posterolateral attachment of the thyroid gland. Blunt dissection can be used to further expose this fascial attachment. Then a harmonic scalpel can be used to transect the ligament. Often, a minimal amount of thyroid tissue is left adjacent to the entrance of the recurrent laryngeal nerve into the larynx, to reduce the risk of injuring the nerve.
If the patient is undergoing a total thyroidectomy, attention should first be turned to the opposite thyroid lobe and recurrent laryngeal nerve. Once the entire specimen has been dissected and is only attached posteriorly to the pretracheal fascia, it can be removed. The removed specimen should be inspected.
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How Do You Prepare For Thyroid Surgery
Before having thyroid surgery, it is important to discuss with your doctor the risks, benefits, and alternatives to proceeding with surgery. Depending on the reason for your thyroid surgery you may require blood work and laboratory testing, in addition to imaging, in preparation for your surgery. Sometimes you may need a biopsy of the thyroid gland to help in deciding the type of surgery you need.
Temporary Or Permanent Hypoparathyroidism:
Surgery of the thyroid gland can cause injury of or accidental removal of a portion of the four parathyroid glands located at the back of the thyroid gland. The parathyroid glands produce parathyroid hormone that helps balance calcium and phosphorus in the kidneys and bones.
Injury to the parathyroid glands can lower the calcium levels in the body, causing hypocalcemia. Hypocalcemia can occur for a few weeks to months following the thyroid surgery and requires calcium supplements. In rare cases, it can be permanent.
Patients can have symptoms like:
- Muscle cramps and twitches
- Depression and difficulty in concentration
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Will I Be Able To Lead A Normal Life After Surgery
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to do anything that you could do prior to surgery. Some patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone . This is especially true if you had your whole thyroid gland removed. Generally, you will be started on thyroid hormone the day after surgery, even if there are plans for treatment with radioactive iodine.
Understanding The Different Types Of Thyroid Surgery
According to the American Thyroid Association, about 20 million Americans have thyroid disease, and more than 12% of Americans will develop thyroid disease during their lifetimes. Many times, thyroid disease can be treated with medication. But sometimes, surgery is the better solution.
At Desert West Surgery, our team of skilled surgeons uses the most advanced thyroid surgery techniques for patients with thyroid disease that cant be treated non-invasively. Heres what you should know about thyroid disease and the surgeries used to manage it.
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Anatomy Of The Recurrent Laryngeal Nerve
The recurrent laryngeal nerve branches off the vagus nerve and is present by the sixth gestational week, associated with the sixth branchial arch. Because the aortic arches are cranial to the larynx at this stage, the nerve does not loop at this point. As the larynx moves cephalad, the recurrent nerve also ascends. Although the distal portion of the sixth aortic arch degenerates on the right, it persists in the left as the ductus arteriosus. For this reason, the left recurrent laryngeal nerve stays below the ductus arteriosus and ascends to the larynx.
On the right, the nerve ascends with the larynx until it reaches the fourth aortic arch . In approximately 1% of the population, the right subclavian arises from posterior to the esophagus, allowing the right recurrent laryngeal nerve to ascend further and enter the larynx directly without forming a loop. Additionally, the loops of the recurrent laryngeal nerves can be reversed in patients with a right-sided aortic arch.
Occasionally, the nerves branches prior to entering the thyroid gland into motor and sensory components. Additionally, a branch of the nerve ascends and anastomoses with the superior laryngeal nerve to form the Galen anastomosis.
What Are Common Tests To Check The Health Of The Thyroid
The first-line test for checking the health of your thyroid is a blood test that measures your levels of thyroid-stimulating hormone . Its a screening test for both hypothyroidism and hyperthyroidism.
In general, the normal range for a TSH blood test is 0.5 to 5.0 mIU/L . However, this can vary from lab to lab and depending on certain factors, such as pregnancy and your age.
Your provider can also check the levels of T4 and T3 in your blood.
If your test results come back abnormal your provider may suggest having an imaging test such as a thyroid scan, which uses small amounts of a safe, radioactive material to create images of your thyroid, or a thyroid ultrasound.
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