Monday, February 26, 2024

What To Expect After Thyroid Lobectomy

How To Maintain Healthy Hormone Levels After A Thyroid Lobectomy

What to Expect After Thyroid Surgery – James Wu, MD

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.

How Long Does Hoarseness Last After Thyroid Surgery

If you do have the hoarseness side effect after your thyroid surgery, it could last anywhere from two weeks after the surgery to three to six months after surgery. As time goes on and the nerves in your throat start to heal, the hoarseness will get better. You may wake up sounding normal but return to hoarseness by the end of the day. Hoarseness will come and go through the recovery process over the course of several weeks to months. This is about the nerves being weak and irritated. As the day goes on, your body continues the healing process some days may be more irritated than others. If hoarseness lasts more than 6 months, then your physician may make various recommendations to improve it.

Hypocalcemia And Bone Health

Your bones have been starved of calcium during the time you have had hyperparathyroidism, and will now have the chance to grow strong again. After successful parathyroid surgery, I recommend plenty of dietary calcium. If you do not take at least three daily servings of calcium-rich foods, you may prefer to take Caltrate Plus twice a day to promote healthy bones. In addition to these supplements, an exercise routine using weights is also recommended. Your vitamin D should be kept > 75 to enable your intestine to absorb the calcium in your diet.

In a small number of patients who have parathyroid surgery, the remaining parathyroid glands have become lazy, and do not function properly immediately after surgery. It is very rare after the mini-surgery, but about 5% if you need both sides of the neck explored. This is usually temporary and causes the blood calcium level to drop below normal . Symptoms of hypocalcaemia include numbness and tingling in your hands, soles of your feet and around your lips. Some patients experience a “crawling” sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours.

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Thyroid Surgery Recovery Side Effects And Complications

If you are having thyroid surgery, known as a thyroidectomy, to remove all or part of your thyroid glanda butterfly shaped organ at the base of your neckit’s important to know what to expect as you recover.

Side effects, such as neck pain and stiffness or sore throat, are common after surgery. Complications are rare but can be serious and even potentially life-threatening if they do occur.

This article explores common side effects of thyroid surgery, what to expect during the recovery process, and warning signs of complications.

Will I Be Able To Lead A Normal Life After Surgery

Pin on Thyroid

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.

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How Does Thyroid Surgery Affect Your Body

If all goes well with your surgery, the conditions it was chosen to treat will be resolved. For example, if a goiter caused an airway blockage, you should be able to breathe better quickly. If the surgery was used to treat thyroid cancer, your health care provider will conduct follow-up monitoring to see the extent of the improvement, if any.

On the other hand, if your entire thyroid was removed, you will have a permanent loss of thyroid function. This is , and it requires a lifetime of thyroid hormone monitoring and .

If your a gland that sits directly behind the thyroid glandis damaged during surgery, you might experience hypocalcemia, or low calcium levels. Low calcium levels may initially cause numbness, tingling, and/or muscle twitching. If left untreated, it can lead to life-threatening seizures and cardiac arrhythmias.

A Change In Thyroid Hormones

If your whole thyroid gland has been removed, you will need to take tablets to replace the hormones that your thyroid would normally make. The thyroid hormones are necessary to keep your body processes going at the right rate. This is called your metabolism. Without thyroid hormones, you feel extremely tired and lacking in energy.

A tablet called thyroxine replaces the hormones. You take this tablet every day for the rest of your life. You have regular blood tests to check the hormone levels in your blood. Your doctor may change the dose of your tablet if your hormone levels are too high or too low.

If you have had part of your thyroid gland removed, the remaining gland usually makes all the hormone you need. But some people might need to take thyroxine tablets. You have blood tests to check for this.

These hormone tablets may help to stop the cancer from coming back in follicular and papillary thyroid cancer. They stop your body from producing another hormone called thyroid stimulating hormone . TSH can help these types of thyroid cancer cells to grow.

Taking thyroxine every day won’t stop you from doing the daily activities you were doing before your surgery.

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How Much Of My Thyroid Gland Needs To Be Removed

Your surgeon should explain the planned thyroid operation, such as lobectomy or total thyroidectomy, and the reasons why such a procedure is recommended.

For patients with papillary or follicular thyroid cancer, many, but not all, surgeons recommend total or neartotal thyroidectomy when they believe that subsequent treatment with radioactive iodine might be necessary. For patients with larger or more invasive cancers and for patients with medullary thyroid cancer, local lymph node dissection may be necessary to remove possibly involved lymph node metastases.

A hemithyroidectomy may be recommended for overactive solitary nodules or for benign onesided nodules that are causing local symptoms such as compression, hoarseness, shortness of breath or difficulty swallowing. A total or near total thyroidectomy may be recommended for patients with Graves Disease or for patients with large multinodular goiters.

Complications Of Thyroid Surgery

What To Expect After Thyroid Surgery

Approximately 150,000 people undergo thyroid surgery each year in the United States. In the vast majority of cases, the potential benefits of surgery outweigh the potential risks. However, you should speak with your health care provider about the potential forserious complications in the lead-up to the surgery.

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What Are The Risks Of A Partial Thyroidectomy

You may bleed more than expected and need a blood transfusion. Your voice may be hoarse or weak after surgery, and this may become a long-term problem. Your neck may be bruised and swollen, and it may be hard for you to breathe or swallow. Your parathyroid glands may not work as well as they should after surgery. This can cause your calcium levels to drop too low. Low calcium levels can cause many problems, including an irregular heartbeat, muscle spasms, and seizures. This may be a short-term problem after surgery, or it may be a long-term problem.

General Risks Of Surgery

The general risks of surgery include:

  • anesthesia reaction, such as an allergic reaction and problems with breathing
  • bleeding, which can lead to shock
  • damage to the parathyroid glands causing problems managing your bodys calcium levels
  • difficulty breathing, which is a rare complication
  • nerve damage, which can lead to permanent hoarseness, coughing, swallowing problems, problems speaking, or other voice changes
  • nerve irritation leading to temporary voice changes, hoarseness, or weakness
  • temporary rise in the level of thyroid hormones

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What To Expect After Surgery

People who have a lobectomy can often go home the day of surgery, but those who have a total thyroidectomy usually need to stay in the hospital overnight. You may experience minor discomfort for a few days, which can be managed with pain medication.

A thyroidectomy stops or decreases production of thyroxine. Your doctor replaces thyroxine with a synthetic hormone called levothyroxine, taken by mouth daily. This medication helps keep your metabolism functioning properly and prevents hypothyroidism.

If you have thyroid cancer, doctors may prescribe levothyroxine to keep thyroid-stimulating hormone levels on the low side or even fully suppressed to minimize the growth of any remaining thyroid cancer cells.

Some people produce enough thyroxine after a lobectomy and do not need levothyroxine. An NYU Langone endocrinologist assesses your hormone levels after lobectomy to determine whether you need medication.

Does Your Voice Change After Thyroid Surgery

Post

One of the first side effects that almost all patients experience immediately after thyroid surgery is their voice changes because the nerves get swollen and irritated during the surgery. While they are healing, your voice could reflect a different sound until you recover. Your voice will sound hoarse in most cases, just like it does when the nerves are irritated with laryngitis.

The voice changing is almost always temporary, but it could last beyond the standard 6-8 weeks for recovery. You will find these nerves take a longer time to heal and can last up to three to six months before your original voice starts to resurface when you speak. Any long-term voice changes are rare in these surgeries and are not a large difference in the voice.

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When Would I Need A Thyroidectomy Surgery

Your healthcare provider may recommend thyroidectomy for any of the following reasons:

  • You have a nodule on your thyroid that might be thyroid cancer.
  • You have a diagnosis of thyroid cancer.
  • You have a large nodule or goiter thats compressing your trachea or esophagus and making it difficult to breathe or swallow.
  • You have a nodule or goiter thats releasing excess thyroid hormone, resulting in hyperthyroidism, and its not responding to other treatment options.

What Happens During A Thyroidectomy Surgery

Before your surgery, an anesthesiologist will give you general anesthesia to relax your muscles, prevent pain and make you fall asleep. Your healthcare team will also place a breathing tube down your throat for the procedure.

During a thyroidectomy, there are a few ways your surgeon can access your thyroid, including:

  • Through a standard incision in your neck.
  • Through a smaller incision with the help of a video camera .
  • With the assistance of a robot through a distant incision in either the axilla or the back of your neck.

Depending on your situation, your surgeon will remove:

  • Part of your thyroid .
  • Most of your thyroid .
  • All of your thyroid .

During surgery for a thyroid cancer diagnosis, your surgeon may sample lymph nodes around your thyroid gland. If found, a pathologist will check the lymph node sample during surgery for evidence of thyroid cancer. If they find cancerous cells, your surgeon may also remove nearby lymph nodes in your neck.

Once your surgeon is done, theyll close the incision with stitches .

Surgery to remove your whole thyroid may take up to four hours. It may take less time if your surgeon removes only part of your thyroid.

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What Can I Expect Once I Decide To Proceed With Surgery

Once you have met with the surgeon and decided to proceed with surgery, you will be scheduled for your pre-operative evaluation You should have nothing to eat or drink after midnight on the day before surgery and should leave valuables and jewelry at home.

The surgery usually takes 2-2½ hours, after which time you will slowly wake up in the recovery room. Surgery may be performed through a standard incision in the neck or may be done through a smaller incision with the aid of a video camera . Under special circumstances, thyroid surgery can be performed with the assistance of a robot through a distant incision in either the axilla or the back of the neck. There may be a surgical drain in the incision in your neck and your throat may be sore because of the breathing tube placed during the operation. Once you are fully awake, you will be allowed to have something light to eat and drink. Many patients having thyroid operations, especially after hemithyroidectomy, are able to go home the same day after a period of observation in the hospital. Some patients will be admitted to the hospital overnight and discharged the next morning.

Gut Health And Your Thyroid

Post-thyroidectomy. One day after my thyroid surgery.

Because of the gut-thyroid connection, improving your gut health can also support your thyroid health . Research shows that gut conditions and poor thyroid health tend to occur alongside each other , and treating gut conditions may support thyroid health .

We have a research-packed article on all the ways you can befriend your gut to keep your thyroid healthy too, but after addressing your nutrition and managing stress, probiotics are a great starting point. Research shows that probiotics may help those who are taking thyroid medication reduce their dosage, because theyre able to absorb it better through the gut lining .

At our clinic, weve been able to help many patients like Monica, a 36-year-old woman who came to us with hypothyroid symptoms that didnt respond to conventional thyroid medication. We were able to get her feeling much better using dietary changes , probiotics, a multivitamin, fish oil, vitamin D, and some supplemental fiber. This significantly improved her symptoms where thyroid medication did not. The root issue was actually a gut problem, not a thyroid problem first.

Listen to the full podcast on Monicas recovery journey here.

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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.

Why Does A Patient Need Thyroid Surgery

There are many reasons why your doctor may have recommended thyroid surgery. Some of the most common reasons include:

  • Thyroid cancer: An overgrowth of cells in the thyroid gland is characteristic of thyroid cancer. The exact cause of thyroid cancer is not known. Treatment for this type of cancer can vary but surgery is one of the most common methods. Other treatment options include hormone therapy, radioactive iodine, radiation and sometimes chemotherapy.
  • Goiter: Goiters are an enlargement of the thyroid gland that appears as a large growth on the front of the neck. Goiters usually occur as a result of iodine deficiency or thyroid inflammation. Smaller goiters that dont cause symptoms may not require treatment but larger goiters that cause discomfort or difficulty breathing do require surgery.
  • Hyperthyroidism: Also known as an over-active thyroid, hyperthyroidism occurs when the thyroid gland produces too much thyroxine . If you are unable to tolerate other treatments for hyperthyroidism, such as antithyroid drugs and radioactive iodine therapy, then surgery would be the next best option.
  • Nodules: Thyroid nodules are lumps that form within the thyroid gland. When should you worry about these nodules? If the nodules are cancerous, then a thyroidectomy will likely be recommended. In some circumstances, it may be difficult for your doctor to determine if your thyroid nodules are cancerous or not. Thyroidectomy might be recommended in these circumstances.

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Natural Support For Thyroid Lobectomy

If you do need to have a thyroid lobectomy, there are several things you can do to support your body before and after surgery.

For pre-surgery recommendations, research shows that optimizing your calcium levels, magnesium, and vitamin D levels is highly supportive of good surgical outcomes and lowers the risk of complications . Addressing any metabolic health conditions like type 2 diabetes, high blood pressure, and overall systemic inflammation also leads to better outcomes and fewer complications .

Post-surgery, there are a few physical exercises like neck stretches, neck massage, and voice therapy that can reduce pain, improve surgical adhesions, and support full recovery .

One randomized controlled trial wanted to see if performing neck stretching exercises after thyroidectomy could improve neck pain. A total of 80 patients who had undergone thyroidectomy were randomly assigned either to perform neck stretches for four weeks or to a control group. The results showed that patients in the stretching group experienced significantly less neck pain and disability than the control group after one week and one month following thyroidectomy .

The stretching exercises consisted of the following eight steps:

  • Relax shoulders and neck sufficiently
  • Slowly raise hands fully then lower them
  • Participants were asked to perform five repetitions of the stretches, three times per day.

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