Thyroid Surgery in Long Island, NY

In modern practice there are three main procedures that are done:

Total Thyroidectomy

In this operation, the surgeon removes the entire thyroid gland.  Indications for this operation include both benign (Graves’ disease, multinodular goiter) and malignant (thyroid cancer) conditions.  Patients who undergo a total thyroidectomy will need to take lifelong thyroid hormone replacement therapy.

Thyroid Lobectomy (Hemithyroidectomy)

In this operation the surgeon removes half of the thyroid and the bridge of tissue that connects the two lobes called the isthmus.  This operation can be done for goiters that affect only one side of the thyroid gland.  It is also commonly done in patients where the needle biopsy has yielded indeterminate results.  In this situation, the thyroid lobectomy is being done as an operative excisional biopsy to determine definitively if the nodule is benign or malignant.  In the majority of patients, indeterminate nodules turn out to be benign and the patient require no further surgery.  However in about 25 percent of patients the nodule will prove to be malignant and the patient will need to have the reminder of the thyroid removed.  This is often done as a second surgery called a completion thyroidectomy because it often takes the pathologist a week or more to arrive at a final diagnosis.

Completion Thyroidectomy

In this operation, the surgeon removes any residual thyroid that exists following a previous operation in which only a portion of the gland was removed.  This situation can occur when the first side was removed for an indeterminate nodule that ultimately proves to be malignant.  It can also occur in patients who had half of the thyroid removed for a goiter in the past who then subsequently developed a large goiter in the remaining portion of the gland.  As with a total thyroidectomy, patients who have undergone a completion thyroidectomy will need to be on lifelong thyroid hormone replacement therapy.

Length of the Procedure

For most patients it takes about 45 minutes to remove half of the thyroid and about an hour and 20 minutes to remove the entire gland.
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Recovery from Thyroid Surgery

In general, patients do not need to be admitted to the hospital following thyroid surgery.  After the operation is completed, the patient is taken to the recovery room for a 6 hour observation period and then discharged home.  Patients who may require admission to the hospital include those on blood thinners and those with large thyroids that extend into the chest.  Most patients are back to their usual activities within a week of the surgery.  It will hurt to swallow after the surgery much like a sore throat from a cold.  Patients are able to swallow anything after the surgery, but the hardest thing to swallow is water because you have to elevate your soft palate the highest to swallow thin liquids.  The easiest thing to swallow is ice cream. Most patients take pain medicine for two or three days following the surgery.  About half get by with Tylenol of Motrin while the rest will take a mild narcotic for which you will receive a prescription prior to leaving the hospital.
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Potential Complications from Thyroid Surgery

Bleeding and infection can happen with any operation.  The risk of needing to return to the operating room for bleeding is about 1 in 300.  In our experience all of these patients were identified within the 6 hour observation period prior to potential discharge.  Infection rates in skin incisions in the head and neck are very low, but are more common in immunocompromised patients.

Injury to the nerve to the voice box, the recurrent laryngeal nerve, occurs in about 1 percent of patients.  If this happens, you will not lose your voice, but your voice will become hoarse.  The hoarseness will last for a period of time ranging anywhere from 6 weeks up to 9 months.  During that period of time, the paralyzed vocal cord will shorten and stiffen and the other vocal cord will learn to accommodate.  So after a period of time, the voice will be quite normal in pitch and tone, but it will always be weaker than it had been in the past.  These patients have difficulty projecting their voice.

There are four glands in the neck that are anatomically located just behind the thyroid called the parathyroids.  There are two on the left and two on the right.  You need one normally functioning parathyroid gland to have normal parathyroid function.  If during a total thyroidectomy or a completion thyroidectomy, the blood supply to all four of the parathyroids is interrupted, you would be left with a situation in which you did not make enough parathyroid hormone.  In this situation, the calcium level in your blood would drop.  Symptoms of low calcium are numbness and tingling in the finger tips and around the lips.  Some patients will also describe cramping in the hands.  The treatment for this is to take calcium supplements by mouth.  After a total thyroidectomy, about 10 percent of patients will experience some tingling.  It typically starts about 24 hours after the surgery and lasts for about one week.  All patients discharged after thyroid surgery are sent home with instructions to take supplemental calcium for the first week.  If you experience tingling, you should take more calcium and call your surgeon.  In most patients the tingling will resolve, however, in 1 out of 200 patients, the parathyroid dysfunction will be permanent and these patients will need to take lifelong calcium supplementation.  Patients at increased risk for parathyroid dysfunction include Graves’s patients, those with thyroiditis and those with very large goiters.
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Incision

The traditional incision for thyroid surgery (called a collar incision) was low in the neck and very long.  Today, this type of incision can generally be avoided.  Rather, the incision is placed high in the neck in a natural skin crease which dramatically reduced the length of the incision needed to perform the surgery.  The scar itself is composed of two things.  First is the normal healing process which is necessary and unavoidable.  The second is reaction to foreign material.  Because sutures are foreign material, they are avoided for this reason.  Instead, your incision will be glued together.  The glue is a clear plastic with a purple tint.  It is ok to take a shower the day after surgery, just do not let the water run right onto the glue.  If the glue gets wet, it may get sticky.  In this case simply fan it dry.  It takes about 7 to 10 days for the glue to curl up and fall off.  After that, everything should be healed up underneath.  Many patients ask about a myriad of skin care products marketed to reduce scarring.  To our knowledge none of these over the counter preparations are harmful and you should feel free to use them if you wish once the glue has come off.  Finally, the scars do tend to darken when they are exposed to sunlight.  So it is a good practice to keep sunblock on the incision when going out into the sun.


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Medications

Patients should resume their preoperative medications following the surgery.  Patients should consult with their surgeon about resuming blood thinners and anti-thyroid medication.  Patients undergoing a total thyroidectomy will be started on a weight based dose of thyroid hormone.  Patients will be given a prescription for narcotics, but should start with Tylenol or Motrin first.  Finally, patients need to take high doses of calcium (1000 mg four times a day) for the first week to treat any potential temporary dysfunction of the parathyroids.
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Links and Additional Information

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