What happens after thyroid surgery?

During the first 24 hours:

After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include:

  • •Bleeding
  • •Bleeding under the skin that rarely can cause shortness of breath, requiring immediate medical evaluation
  • •A hoarse voice
  • •Difficulty swallowing
  • •Numbness of the skin on the neck
  • •Vocal cord paralysis•
  • Low blood calcium

At home:

Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you prior to your discharge. Medications may include:

  • •Thyroid hormone replacement
  • •Calcium and/or vitamin D replacement

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:

  • •Numbness and tingling around the lips and hands
  • •Increasing pain
  • •Fever
  • •Swelling
  • •Wound discharge
  • Shortness of breath

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

There is good news if thyroid surgery becomes necessary. Over the last decade there have been major advances in the way thyroid surgery is performed. Improvements in technologies and techniques have now made thyroid surgery very safe, effective and relatively easy to recover from.

Different types of thyroid surgery are now available to patients, including minimally invasive procedures that cause less pain, allow easier recoveries, and result in smaller incisions.

Based on the type of disease, experience of the doctor and preferences of the patient, an optimal surgery can be chosen.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The most important step before undergoing thyroid surgery is to be certain that the planned surgery is appropriate for the diagnosis. In order to properly treat the disease, sometimes a partial or total thyroidectomy is necessary and in some patients lymph nodes also need to be removed during the surgery.

To determine the proper surgery, physicians may order blood tests and radiology studies, including an ultrasound or CT scan. Also, some patients may be asked to see their primary care doctor to make sure that their overall health is good enough to have surgery.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the throat. It has two lobes joined in the middle by a strip of tissue (the isthmus). The thyroid secretes three main hormones: 1) Thyroxine, that contains iodine, needed for growth and metabolism; 2) Triiodothyronine, also contains iodine and similar in function to Thyroxine; and 3) Calcitonin, which decreases the concentration of calcium in the blood and increases calcium in the bones. All three of these hormones have an important role in your child’s growth.

Thyroid cancer is the third most common solid tumor malignancy and the most common endocrine malignancy in children. It occurs four times more often in females than males and has similar characteristics as adult thyroid cancer. Surgery is the preferred treatment for this cancer. Although the procedure is often uncomplicated, risks of thyroid surgery include vocal cord paralysis and hypocalcemia (low blood calcium). Consequently, an otolaryngologist – head and neck surgeon, one experienced with head and neck issues, should be consulted.

Types of thyroid cancer in children:

Papillary: This form of thyroid cancer occurs in cells that produce thyroid hormones containing iodine. This type, the most common form of thyroid cancer in children, grows very slowly. This form can spread to the lymph nodes via lymphatics in the neck and occasionally spreads to more distant sites.

Follicular: This type of thyroid cancer also develops in cells that produce thyroid hormones containing iodine. The disease afflicts a slightly older age group and is less common in children. This type of thyroid cancer is more likely to spread to the neck via blood vessels, causing the cancer to spread to other parts of the body, making the disease more difficult to control.

Medullary: This rare form of thyroid cancer develops in cells that produce calcitonin, a hormone that does not contain iodine. This cancer tends to spread to other parts of the body and constitutes about 5-10 percent of all thyroid malignancies. Medullary thyroid carcinoma (MTC) in the pediatric population is usually associated with specific inherited genetic conditions, such as multiple endocrine neoplasia type 2 (MEN2)

Anaplastic: This is the fastest growing of the thyroid cancers, with abnormal cells that grow and spread rapidly, especially locally in the neck. This form of cancer is not seen in children.

Symptoms: Symptoms of this disease vary. Your child may have a lump in the neck, persistent swollen lymph nodes, a tight or full feeling in the neck, trouble with breathing or swallowing, or hoarseness.

Diagnosis: If any of these symptoms occur, consult your child’s physician for an evaluation. The evaluation should consist of a head and neck examination to determine if unusual lumps are present. A blood test may be ordered to determine how the thyroid is functioning. Ultrasonography uses sound waves and a computer to create an image of the thyroid gland and neck contents such as lymph nodes. Other tests that may be warranted include a radioactive iodine scan, which provides information about the thyroid shape and function, identifying areas in the thyroid that do not absorb iodine in the normal way, or a fine needle biopsy of any abnormal lump in the thyroid or neck. Sometimes it is necessary to remove a part of the tumor or one of the lobes of the thyroid gland, known as a thyroid lobectomy, for analysis to help establish a diagnosis and plan for management.

Treatments for thyroid cancer:

If the tumor is found to be malignant, then surgery is recommended. Surgery may consist of a lobectomy, subtotal thyroidectomy (removal of at least one lobe and up to near-total removal of the thyroid gland), or a total thyroidectomy. In children with papillary or follicular thyroid cancer, total or near-total thyroidectomy is currently the standard of practice, as children typically have more extensive disease at presentation, have higher rates of spread, and it reduces the risk of recurrence. In children, there is an increased need for repeat surgery when less than a total thyroidectomy is performed. Lymph nodes in the neck may need to be removed as part of the treatment for thyroid cancer if there is suspicion of spread of cancer to the lymph nodes.

Surgery may be followed by radioactive iodine therapy, to destroy cancer cells that are left after surgery. Thyroid hormone therapy may need to be administered throughout your child’s life to replace normal hormones and slow the growth of any residual cancer cells.

If cancer has spread to other parts of the body, chemotherapy (treatment by chemical substances or drugs) may be given. This therapy interferes with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Radiation treatment may also be required for treatment of some forms of thyroid cancer.

In general, treatment outcomes for this type of cancer in children tend to be excellent. The best outcomes are seen in teenage girls, papillary type cancer, and tumors localized to the thyroid gland.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism. Diseases of thyroid, whether functional (hypothyroidism, hyperthyroidism) or structural (nodule, goiter, cancer) occur very commonly.

A nodule is an area of abnormal growth within the thyroid gland. Some people have a single nodule while others have multiple nodules within the gland. Thyroid nodules, which are particularly common in women, can be tiny to very large in size.

Most thyroid nodules are non-cancerous, do not cause symptoms and do not need any treatment. However, in some cases because of the size, appearance (on radiology tests) or symptoms caused by the nodule further evaluation and treatment is needed.

Some nodules are cancers and need therapy. Other nodules are big enough to cause a goiter, leading to symptoms like difficulty swallowing or breathing. In some cases the nodule can be overactive, making too much thyroid hormone (hyperthyroidism). The best treatment option is based on the type of nodule and the preferences of the patient. In some cases thyroid surgery is necessary.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Other endocrine glands include the pituitary, adrenal and parathyroid glands and specialized cells within the pancreas.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.

What is a thyroid disorder?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

  • An overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
  • An underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis)
  • Thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”.

Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acne, adenoids or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

Hypothyroidism treatment:

  • Thyroid hormone replacement pills

Hyperthyroidism treatment:

  • Medication to block the effects of excessive production of thyroid hormone
  • Radioactive iodine to destroy the thyroid gland
  • Surgical removal of the thyroid gland

Goiters (lumps):

If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He or she may recommend:

  • An imaging study to determine the size, location and characteristics of any nodules within the gland. Types of imaging studies include CT or CAT scans, ultrasound or MRIs.
  • A fine-needle aspiration biopsy – a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, and tissue fluid samples containing cells are taken. Several passes with the needle may be required. Sometimes ultrasound is used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure. This test gives the doctor more information on the nature of the lump in your thyroid gland and may help to differentiate a benign from a malignant or cancerous thyroid mass.

Thyroid surgery may be required when:

  • the fine needle aspiration is reported as suspicious or suggestive of cancer
  • imaging shows that nodules have worrisome characteristics or that nodules are getting bigger
  • the trachea (windpipe) or esophagus are compressed because one or both lobes are very large

Historically, some thyroid nodules, including some that are malignant, have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically, the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed during the same surgery.

Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This decision is usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you pre-operatively.

As an alternative, your surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. There also may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist to answer them in detail.

What happens after thyroid surgery?

During the first 24 hours:

After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include:

  • Bleeding
  • Bleeding under the skin that rarely can cause shortness of breath, requiring immediate medical evaluation
  • A hoarse voice
  • Difficulty swallowing
  • Numbness of the skin on the neck
  • Vocal cord paralysis
  • Low blood calcium

At home:

Following the procedure, if it is determined that you need to take any medication your surgeon will discuss this with you prior to your discharge. Medications may include:

  • Thyroid hormone replacement
  • Calcium and/or vitamin D replacement

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:

  • Numbness and tingling around the lips and hands
  • Increasing pain
  • Fever
  • Swelling
  • Wound discharge
  • Shortness of breath

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.

How is a diagnosis made?

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. In addition, blood tests and imaging studies or fine-needle aspiration may be required. As part of the exam, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Tests your doctor may order include:

  • Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
  • An ultrasound examination of your neck and thyroid
  • Blood tests of thyroid function
  • A radioactive thyroid scan
  • A fine-needle aspiration biopsy
  • A chest X-ray
  • A CT or MRI scan

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism.

Thyroid cancer is very common, particularly in women. It is now one of the most common cancers found in women. In most patients it does not cause any symptoms, though it sometimes can lead to difficulty swallowing, voice changes or a lump in the neck. Often thyroid cancers are found within nodules that are either felt by the patient or their doctor. These nodules are also frequently found incidentally, when the patient has a radiology test not related to the thyroid. A biopsy may be performed based on physical exam and radiographic findings. In some patients, a biopsy may show a cancer before surgery and in others a cancer may only be found after surgery is completed.

Types of Thyroid Cancer

There are several types of thyroid cancer. Most patients have papillary thyroid cancer, which typically has a good prognosis. The main treatment for thyroid cancer is surgery. This surgery will involve removing the thyroid and sometimes enlarged lymph nodes.

  • Papillary: The most common form of thyroid cancer. This type of cancer, which tends to grow slowly, has a good prognosis. It is treated with thyroid surgery and, in selected cases, radioactive iodine.
  • Follicular: This type of thyroid cancer also typically has a good overall prognosis. It is treated similarly to papillary carcinoma, with thyroid surgery and in selected cases, radioactive iodine.
  • Medullary: This form of thyroid cancer develops from cells in the thyroid gland that are different from papillary and follicular thyroid cancers. While the prognosis with medullary cancer is not as favorable when compared with those types of thyroid cancers, it is also much less common (between 5-10 percent of all thyroid cancers). Medullary thyroid carcinoma can be associated with several inherited syndromes but most cases happen in patients without any family history. Treatment for medullary thyroid cancer is primarily surgery.
  • Anaplastic: This is the least common type of thyroid cancer but it is very aggressive. This cancer often grows very quickly and requires a multidisciplinary medical team to determine the best treatment plan.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism.

In hyperthyroidism, the thyroid gland is producing too much hormone. This excess of thyroid hormone causes the metabolism to be overactive. Patients with hyperthyroidism can experience a number of symptoms, including a racing heart, tremors, feeling anxious, weight loss, feeling hot all the time and difficulty sleeping. A simple blood test can diagnose hyperthyroidism.

In some patients, hyperthyroidism is caused by the whole gland being overactive (Graves’ disease), while in others a nodule or nodules may be causing the problem. Treatment for hyperthyroidism includes medications, radioactive iodine or thyroid surgery. The best therapy depends on the cause of the hyperthyroidism and the preferences of the patient.

In hyperthyroidism, too much thyroid hormone causes the body’s metabolism to become overactive.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism.

In hyperthyroidism, the thyroid gland is producing too much hormone. This excess of thyroid hormone causes the metabolism to be overactive. Patients with hyperthyroidism can experience a number of symptoms, including a racing heart, tremors, feeling anxious, weight loss, feeling hot all the time and difficulty sleeping. A simple blood test can diagnose hyperthyroidism.

In Graves’ disease the body causes the whole thyroid gland to become overactive. In addition to the thyroid gland, the eyes can be affected. The eyes can start to bulge, become dry and itchy and vision can become blurry.

Treatment for Graves’ disease includes medications, radioactive iodine or thyroid surgery. Therapy depends on the response of the patient to treatment, the presence of eye symptoms and the preferences of the patient.

In hyperthyroidism, too much thyroid hormone causes the body’s metabolism to become overactive.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism. Thyroid diseases, whether functional (hypothyroidism, hyperthyroidism) or structural (nodule, goiter, cancer), are very common in both women and men.

Goiter refers to an enlarged thyroid gland. In some parts of the world goiters develop because of a lack of iodine in peoples’ diets. However, in the United States where iodine is added to foods, goiters are most often caused by other problems. A single or multiple nodules, Graves’ disease, and hyperthyroidism can all lead to the development of a goiter.

As goiters become bigger they can put pressure on the trachea (windpipe) or esophagus (food pipe), causing symptoms like difficulty swallowing, difficulty breathing (particularly when lying down), a choking sensation or pressure in the neck. When patients start to experience symptoms, treatment is often offered. The exact type of treatment is based on the cause of the goiter and the patient’s preferences. In some cases thyroid surgery is the best treatment option.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery