Thyroid Preparation for Surgery

Aside from the routine pre-operative tests that may be required to assess the patient’s overall health (i.e. blood tests, chest X-ray, EKG), the evaluation of a patient prior to thyroid surgery may include:

Imaging studies — ultrasound, chest X-ray, CAT scan, RAI scan

Blood tests — to check thyroid and parathyroid function

Fine-needle aspiration biopsy — to assess for malignancy.

Rarely, the surgeon may also need to do additional evaluations, based on the physical examination or history of the patient. These include:

Vocal cord evaluation — to determine how well the nerves that go to the vocal cords are working. The evaluation of the vocal cords is done with a flexible laryngoscope (small tube with a camera on the end) in the office. This procedure is called a “flexible laryngoscopy.” This test will almost certainly be done if you have developed hoarseness or if you have had a previous neck operation.

Trachea evaluation — CAT scan or bronchoscopy (small tube with a camera on the end) may be done if a large thyroid is pushing on the trachea (windpipe). A large mass may cause a deviation or a narrowing of the trachea. In cases of advanced cancer, the tumor may invade (i.e. grow) into the trachea.

Esophageal evaluation — barium swallow study esophagram or endoscopy may be performed if there is concern about involvement of the esophagus.

Some patients (especially those with hyperthyroidism) may require special medications prior to thyroid surgery. The approach to surgery is very individualized. The conversation with your surgeon will include the type of operation, type of anesthesia, risks of the operation, expected length of hospitalization, and the follow up that will be necessary after your operation. (See The Office Visit)