Thyroidectomy and Parathyroidectomy

Thyroidectomy and Parathyroidectomy - Thyroidectomy

TSH then tells the thyroid gland to make more or less thyroid hormone. An under-active thyroid results in hypothyroidism, producing overall less thyroxine. An over-active thyroid results in hyperthyroidism, producing overall more thyroxine. The parathyroid glands are small endocrine glands located behind the thyroid in the neck that produce parathyroid hormone called parathormone (PTH), which controls the amount of calcium in the blood and within the bones.

The thyroid gland is a bi-lobed endocrine gland located at the base of your neck. It is one of the largest endocrine glands in the body. It creates and secretes thyroxine hormone that is sent into your bloodstream. The thyroid hormone controls the speed of your body’s metabolism. The pituitary gland (located in your brain) controls how much thyroxine to make. It does this by making thyroid stimulating hormone (TSH).

Goiter

Thyroid goiter is an enlargement of the thyroid gland. It can become larger because your thyroid is trying to make more thyroid hormone. Also, with hyperthyroidism the cells grow faster, which causes the thyroid to grow and make more thyroid hormone than the body needs.

Nodules

Thyroid nodules can be either solid or cystic (fluid filled). Typically, your thyroid gland works normally if you have nodules. Most nodules are not cancerous. There are different ways to evaluate thyroid nodules to determine whether or not they are cancerous, but the most accurate and minimally invasive way is to obtain an ultrasound guided biopsy of the nodule by fine needle aspiration (FNA). If the pathology is non-determinant with significant patient risk factors, or suspicious/diagnostic for cancer, then surgical removal of either one or both thyroid lobes is then recommended.

Thyroidectomy is an operation in which one or both lobes of the thyroid gland are removed. The most common indications for thyroidectomy include a large mass in the thyroid gland, difficulties with breathing related to a thyroid mass, difficulties with swallowing, suspected or proven cancer of the thyroid gland and hyperthyroidism.

Side Effects / Risks

Two complications specific to thyroid surgery are hypocalcaemia, which is low blood levels of calcium, and vocal cord weakness or paralysis. Hypocalcemia is usually temporary, but may sometimes require calcium supplements. Difficult or painful swallowing, which usually resolves within 72 hours. Bleeding and/or numbness is also a possible short- term complication.

Pre-Operative Instructions

When the decision for surgery has been made, the office will try to determine a day that is most convenient for you. Once the surgery day is confirmed with the hospital, you will need to contact your family doctor and schedule a preoperative appointment within 30 days of your surgery day. You should obtain a History and Physical as well as any necessary blood work.

You will be contacted by the hospital on the business day before your procedure. You must arrive at the hospital two hours prior to your scheduled time. This allows the staff enough time to prepare you for your procedure. Be prepared to spend a day or two in the hospital for observation. You should leave all valuables at home and arrange for a ride home once you are discharged.

The outcome of your surgery is as important to us as it is to you. In order to obtain the best results with your procedure, we would like you to follow a few simple rules.

Two Weeks Before Surgery

  1. Do not drink alcohol for two weeks prior and two weeks after surgery.
  2. Absolutely DO NOT take any aspirin, aspirin-containing products, ibuprofen (Advil®, Aleve®, Motrin, etc). The only “safe” pain medication that is permitted is Tylenol. Do not buy any over the counter pain medications without checking with the Doctor first.
  3. DO NOT take Vitamin E. It is known to increase bleeding during surgery. If you are on any medications that affect bleeding such as coumadin, warfarin, or plavix please notify the office as well as your primary physician to discuss important directions on how to stop the medication

One Week Before Surgery
You will need to schedule an appointment at our office one week prior to your surgery. Please bring your History and Physical and all labs with you. At your appointment, you will be given prescriptions for an antibiotic and pain management. These will all be used following your surgery. Please fill these prescriptions before your surgery so you will have them ready for use when you return home after your surgery has been completed.

The Day Before Surgery
NOTHING TO EAT OR DRINK AFTER MIDNIGHT. No water or gum chewing either. Your procedure will be cancelled if you do not follow these directions.

Post-Operative Instructions

After surgery, no strenuous activity such as bending, lifting, or straining for two weeks after surgery. You should schedule an appointment one week following your procedure, at which time pathology results should also be available. You will also be directed back in the care or your family doctor or referred to an endocrinologist for follow up care regarding medications for thyroid replacement and calcium supplements. Please be aware that it is common to have a feeling of numbness, stiffness, or discomfort of the neck following your surgery. Remember that the healing process takes time.

Diet
Advance diet from liquids to soft food to solids as tolerated. Try to avoid hot liquids or food.

Medications
Use pain medication as directed and as needed. Start your antibiotic on the day following your procedure. Take your antibiotics as directed by the doctor. It is not uncommon to have a low-grade fever following surgery. If your fever gets to be higher than 101° F contact our office.

Wound Care
You will have steristrips over your incision. These must be kept dry in order to remain in place. You may shower and wash your hair as long as they are covered.

Notify the Office
If you have difficulty breathing or painful swallowing
Are not able to eat or drink
Coughing up blood or persistent bleeding (some slight blood in sputum is common)
Significant swelling of the neck or back of the throat
Fever above 101º F