Thyroidectomy Tips

Facing the Music

The diagnosis of thyroid cancer proceeds in stages. First, there's a visit to the ENT for some reason, such as investigating a suspicious lump in the throat or wanting a consult on nasal surgery to deal with sleep apnea. The ENT finds a suspicious tumor and sends you on for an ultrasound imaging of the tumor. The ultrasound is inconclusive, but worrisome: there's a suspicious of cancer. The ENT brings you back for a fine needle aspiration (FNA) which either confirms a malignant cancer tumor or is further inconclusive, meaning the tumor needs to be biospied during invasive neck surgery. Either way, it's off to surgery (if the FNA concludes the tumor is non-malignant, then you're done and bless your good fortune).

My point is that scheduling a thyroidectomy is the first time a potential cancer patient has to acknowledge that they may have, or do have, thyroid cancer. Up until scheduling the surgery, it's all theoretical and inconclusive, but when the surgery is scheduled, it becomes very real. It's natural to feel anxiety, frustration, or anger at this point. I'm not going to go into the five stages of grief or anything, but I will say that feeling emotional when scheduling the surgery is natural and normal. The best thing to do is to try to stay positive and focus on the next step: the surgery. Worrying about life without a thyroid, the effects of radioactive iodine, and all that can come after the surgery.

Preparing for a Thyroidectomy

The first and most important thing to when preparing for thyroid surgery is to get a highly experienced surgeon. You want a surgeon who does hundreds of thyroid surgeries per year, because there is a very real chance of permanent vocal damage or crippling damage to the nerves that control movement to your arms. With an experienced surgeon, that chance is around 1% and is almost always temporary. Rates go up rapidly with less experienced surgeons. Get a surgeon who does a lot of thyroid surgeries!

The rest of this advice is based on my personal experience and the collected recommendations of a lot of cancer survivors. Thyroidectomies vary greatly in how long they take and how difficult they are to recover from: some people are done in a few hours, released from the surgery center the same day, and recover entirely within a week. Others are under anesthesia for twelve hours, in the hospital for several days, and take weeks to recover. I'm in the latter group, so some of these suggestions may turn out to be overkill. It's better to be overprepared than underprepared.
  1. Get some bloodwork done. Ideally, you should have bloodwork going back a couple of years with your TSH, free T3, and free T4 levels, but even a bloodwork taken the moment you got the ultrasound of a suspicious tumor in your neck is going to be useful. Basically, after a total thyroidectomy, you and your endocrinologist are going to be experimenting with synthetic T4 and synthetic T3 tablets to determine how much you need to feel healthy and well and not be hypothyroid or hyperthyroid. If you have some numbers personal to yourself to aim for, that's going to be better than just aiming for "within the normal range" which is apparently pretty broad and doesn't suit a lot of people.
  2. Find out if you're going to have drains. Drains are flexible plastic tubes that pierce your skin and then hang outside your body and feed into little plastic collection bottles and let various gross fluids drain from the inside of your neck into the bottles. Drains are also a huge pain in the ass. The piercings are painful in and of themselves and the bottles have to be carried around, and you have to sleep with your head elevated as long as the drains are in. If you're going to have drains, bring a fanny pack to the hospital so you can carry the drains hands-free and get a wedge pillow or two so it's easy to sleep with your head elevated when you get home.
  3. Do all the prep work recommended by your hospital. You'll be under general anesthesia so go in with an empty stomach and don't drink any fluids for at least 8 hours before the surgery, etc. The hospital will give you a list of things to do. Read it, do them.
  4. Bring cough drops or throat lozenges in case your throat is irritated by the breathing tube used while you're under anesthesia.
  5. Bring a pair of shorts to the hospital. After the surgery, you'll be in a stupid hospital gown but you'll be expected to get up and walk around some. Wear some shorts under the gown so you can walk around without having to worry about flashing everyone.
  6. Bring comfortable blankets and pillows from home. Hospital blankets are awful and hospital pillows aren't much better. Bring a comfortable blanket from home to minimize discomfort. If you've spent any time optimizing your pillows at home, bring them too so you benefit from that optimization.
  7. Bring reading material. You will be bored at some points, so have books or a tablet/smartphone with the Kindle reader on it, whatever you prefer. A laptop is probably overkill and hospitals don't make it easy to plug them in.
  8. Contact friends and family and invite them to visit you in the hospital. Human contact will cheer you up.

Parathyroid Trauma and Thyroid Surgery

The parathyroid glands are attached to the thyroid glands and secrete hormones that allow calcium to be digested. During a thyroidectomy, they're often cut up and/or completely traumatized and stop producing those hormones for up to six months.

You and your doctor should monitor your blood to see if you're absorbing enough calcium after thyroid surgery. If you aren't, you're hypocalcemic, and will get unpleasant symptoms likes pins and needles in your hands, feet, and lips. If your'e hypocalcemic long enough, you can suffer something akin to a heart attack and die. The first step to treating hypocalcemia should a prescription for Calcitriol or some other activated vitamin D3. Some doctors tell hypocalcemic patients to take more Tums or other calcium supplement, and normally that's a good idea, but if your parathyroid glands are traumatized and not producing activated vitamin D3, all the oral calcium supplements in the world won't help because your intestines are incapable of absorbing the extra calcium.

Total thyroidectomies and hypothyroidism

After a total thyroidectomy, your doctor should put you on a thyroid hormone replacement medication or you will become hypothyroid. Thyroid hormone stays in your body for a few weeks even after your thyroid is removed, so hopefully you won't have problems until after you have follow-up meetings with your endocrinologist. Getting the right dosages of thyroid hormone replacement medication is a really complicated subject, and it's something you can, should, and to a certain extent must wait to worry about until after your thyroid surgery.

Recovering from a Thyroidectomy

A thyroidectomy is exhausting. It can take time to recover from it. At a minimum, expect to spend at least a week feeling tired and in pain, and maybe as long as a month or more for older people who undergo long surgeries.

Most people can go back to work at a desk job within days of the surgery, though it helps to have a flexible schedule. More physically demanding jobs will need to wait longer, though again, it varies a lot depending on the age of the patient and the length of the surgery. Consult with your surgeon before the surgery, since she should have a good idea of how long your surgery will take and how long it will take for you to recover.

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