Thyroidectomy

Thyroid cancer is a condition in which cancerous thyroid cancer cells develop in the tissues of the thyroid gland.  Fortunately, most nodules in the thyroid gland are not cancerous.  There are different kinds of thyroid cancer.  The risk of thyroid cancer depends on the patient’s past history of radiation exposure, the patient’s gender, and the patient’s age.  Some thyroid cancers are hereditary. 

The patient’s primary care physician may find a nodule on the patient’s thyroid gland during a regular doctor’s visit.  If a nodule is found, a biopsy is done to see if it is cancerous.  If the nodule is cancerous, it needs to be removed or treated with radioactive iodine treatments.  The radioactive iodine kills all the cancerous cells, along with the normal cells in the thyroid gland. This means that the patient may be hypothyroid for the rest of their lives and will need to be on thyroid replacement hormones.

There are several types of thyroid cancer.  There is papillary thyroid cancer (the most common kind of thyroid cancer), follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer (which is the most serious type of thyroid cancer. 

Risk factors for thyroid cancer include having certain genetic problems that predispose a person to having thyroid cancer, being of Asian descent, having a family history of cancer, having an enlarged thyroid gland, being exposed to neck radiation in the past, being female, and being between 25 and 65 years of age.  Medullary thyroid cancer is considered hereditary. 

The typical signs of thyroid cancer include having hoarseness, difficulty swallowing, difficulty breathing, or a lump in the neck.  Sometimes the patient has no symptoms or signs at all and only finds out that they have thyroid cancer if the doctor happens to find a lump in the neck at the time of a routine examination. 

In preparation for thyroid gland surgery, the patient will need to have a preoperative history and physical examination.  This is done by the patient’s primary care physician.   During this examination, the doctor will do a complete history and physical examination, do blood tests, an EKG, and possibly a chest x-ray.  These things are forwarded to the hospital or surgical center to be used on the day of surgery. 

If the patient is taking a blood thinner, aspirin, or a nonsteroidal anti-inflammatory medication, they need to stop taking these medications prior to surgery. The doctor will tell the patient when it is time to stop these medications.  The patient should also stop smoking at least two weeks prior to surgery.  Smoking can interfere with healing and should be stopped at least 2 weeks before surgery.  For the best healing, the patient should continue smoking cessation after the surgery is over with.

The patient should also stop drinking before thyroid cancer surgery.  They need to be honest with their doctor about how much alcohol they are taking in and should consider taking a medication to prevent withdrawal symptoms that might occur if the patient is a heavy drinker.  If the patient cannot stop drinking, they need to let the doctor know so they can receive help in quitting drinking before the surgery. 

The patient should have their preoperative physical within a couple of weeks prior to having surgery.  They can continue to take their regular medications (except for blood thinners) up to the day of surgery.  The doctor will tell the patient if they need to take a medication on the day of surgery with a small sip of water.  Insulin should be taken on the day of surgery but the dose will need to be reduced as the patient will not be eating much on the day of surgery.  

The patient should complete a health care proxy form prior to surgery.  This is a legal document that identifies what the patient’s wishes are regarding their care at the hospital.  They will be able to identify the person they wish to have make healthcare decisions for them should they be unable to make decisions for themselves.  The patient should also identify who their caregivers will be after they have surgery. 

The patient will need to practice coughing and deep breathing exercises before surgery.  The doctor will give the patient an incentive spirometer that can help them expand their lungs. A calcium supplement should be purchased before surgery as the patient will need to take calcium supplements for the rest of their life after the thyroid gland has been removed.

Seven days before surgery, the patient will need to stop taking herbal supplements and other remedies as they can cause problems during and after the surgery.  On the day prior to surgery, they need to call the hospital or doctor’s office to make sure they know when to come to the hospital on the day of surgery.  They need to get plenty of sleep, especially on the day before surgery as they will likely have to get up early for surgery. 

After surgery, the patient will wake up in the recovery room. They need to be monitored by the recovery room staff during this time. There may be a drain in the patient’s neck after surgery that will be removed after the drain stops draining fluid.

The patient may have a hoarse voice and neck pain after surgery.  This doesn’t mean that these are permanent problems and they usually go away after the patient has recovered for a few days.  Most of the hoarse voice and neck pain come from having an endotracheal tube in place during surgery.  After the recovery room, the patient will be moved to a regular hospital bed, which may be in the intensive care unit or a regular hospital bed.  The patient should be able to eat normally after surgery and will just have to stay overnight before being discharged.

Thyroid cancer treatment is done any time there is documented evidence of thyroid cancer following a thyroid nodule biopsy.  Some patients will have surgery, while others will have radioactive iodine treatment instead of surgery.  Radiation therapy and chemotherapy may be indicated after the initial treatments.

After the surgery, the patient will need time for their health to recover and for the wound to turn into a scar.  If there are sutures after surgery, the patient may need to come back to the surgeon’s office to have them removed.  This is done about ten days after surgery.  The patient will also need pain medications to take home.  The doctor will provide those pain medications at the time of discharge from the hospital. Most people will be able to return to work two weeks after the procedure but they may still have some residual neck pain and stiffness, for which they need to take a nonsteroidal anti-inflammatory agent (after the narcotics have been used up). 

It is essential that the patient takes the time to recover after surgery.  This type of surgery is a major procedure and it takes time to completely heal.  If the patient has any concerns after surgery, they need to talk this over with the doctor’s nurse or the surgeon himself.