The American Association of Endocrine Surgeons, Patient Education Site

Thyroid surgery: Recovery

1. Overview

After surgery, the patient will have a sore throat. Mild hoarseness is common and should go away within one to two weeks. There is not much pain involved with thyroid surgery. Rarely, narcotic pain medication (such as morphine) is required afterwards in the recovery room. Most patients, in fact, will just need acetaminophen (Tylenol) to control their discomfort.

The patient can usually eat and drink normally the night of the procedure. The incision is usually closed with absorbable sutures and surgical tape or glue. A light bandage that may be placed in the operating room should be removed the following morning. Patients may shower the next morning and get the incision wet but should not soak it in water (i.e. no soaking in a tub or swimming) for one week.

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2. Hospital stay or outpatient surgery

The decision to stay overnight or discharge a patient the night of the operation depends on the surgeon's practice and the patient's disease. Patients who stay overnight should expect to spend two to six hours in the recovery room where they will be closely monitored for swelling in the neck, which could be a sign of early postoperative bleeding, requiring urgent re-operation. Fortunately this is a rare event. After this observation period, patients are then sent to a regular floor bed. Typically, patients will have a calcium level checked in the morning to look for low calcium levels caused by manipulation of the parathyroids during surgery. Low calcium levels will likely require temporary calcium supplements upon discharge.

In some institutions, patients are able to leave the hospital the day of the operation. Patients who are discharged the day of the operation should expect to spend up to six hours in the recovery room where they will be closely monitored for swelling in the neck, which could be a sign of early postoperative bleeding, requiring urgent re-operation. Fortunately this is a rare event. After this observation period, patients are then discharged home.

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3. What will the scar look like?

The incision will be slightly raised, and there may be slight swelling and bruising noted. These signs should disappear in approximately six weeks. Significant swelling the day after surgery is unusual, and the patient should call their surgeon if this is noted. The incision is preferably made in a natural skin crease in the neck. In this way, the scar should be camouflaged by this crease and the best possible cosmetic effect is achieved. Complete healing may take up to six to eight months.

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4. When can I return to work and normal activity?

The neck muscles may feel stiff and sore for a few days. Most patients return to their daily activities in a few days and work, with some limitations, within a week. Strenuous activity and heavy lifting should be avoided for at least a week. During this time it is helpful to move the neck from side to side and roll the shoulders with gentle stretches to prevent stiffness.

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5. Follow up appointment

A follow-up visit with your surgeon is necessary approximately two to three weeks after the operation. The wound should be well healed by this time and it allows the surgeon to discuss and review the operation, postoperative course, as well as pathology results.

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6. Will I need new medications?

Thyroid hormone replacement is given immediately after a total thyroidectomyTotal thyroidectomy - removal of the whole thyroid if cancer is not involved. If patients have cancer, the thyroid replacement dose and type of thyroid medication will be dictated by the surgeon in the upcoming few weeks after surgery. Food, daily medications, and vitamins can keep thyroid hormone from being fully absorbed. It is important that thyroid hormone replacement pills and calcium supplements not be taken at the same time, to allow for better absorption of the thyroid hormone replacement pill. It is best to wait at least thirty minutes to one hour after taking the hormone supplement before eating or drinking. It usually takes several weeks for the blood levels to reach a new equilibrium, therefore the first TSHTSH - Thyroid stimulating hormone; also known as thyrotropin. The hormone that causes the thyroid to make and release thyroid hormone blood test is performed four to six weeks after surgery. The dose of thyroid hormone is based on the patient's body weight. However, several adjustments may be needed. In general, patients should not gain weight or notice a difference in energy levels during this adjustment period.

Patients who were discharged on thyroid medication and/or calcium supplements may have their levels checked and appropriate changes made at their follow up appointment.

7. Will I need supplemental calcium/vitamin D?

If signs of low calcium level occur, then calcium and/or vitamin D pills may be advised. These levels are straightforward to follow with a simple blood test and respond very well to the supplements. (See Complications of thyroid surgery) Currently, most calcium supplements have vitamin D with them to allow for better absorption

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