Thyroidectomy complications
What are the complications of thyroid surgery (thyroidectomy)?
What happens to your body after thyroid removal?
What should I watch after thyroidectomy?
What nerve can be damaged during thyroidectomy?
After Thyroidectomy
What are the complications of thyroid surgery (thyroidectomy)?
major complications of Thyroidectomy include bleeding, injury to the recurrent laryngeal nerve, hypoparathyroidism, hypothyroidism, thyrotoxic storm, recurrent laryngeal nerve injury.
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- Bleeding in the neck
As with any operation, there is always a chance of bleeding. The average blood loss for thyroid operations is usually small and the chance of needing a blood transfusion is extremely rare. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. Patients are observed overnight. If there is no sign of bleeding and the patient feels well, they will go home the next morning. Once at home, patients should watch for signs, such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to enlarge, and a feeling that something bad is happening.
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- Hoarseness/Voice Change (recurrent laryngeal nerve injury)
There are two sets of nerves near the thyroid gland that help control the vocal cords. These are the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve. Damage to a recurrent laryngeal nerve can cause you to lose your voice or become hoarse. Temporary hoarseness, voice tiring, and weakness can occur when one or more of the nerves are irritated during the operation or because of inflammation that occurs after the surgery. This usually gets better within a few weeks, but can take up to 6 months to resolve. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve voice quality. An otolaryngologist or Ear, Nose, & Throat specialist can be very helpful in determining the specific problem and can perform different procedures to help improve voice quality.
- Hypocalcemia (Hypoparathyroidism)
Hypocalcemia (low blood calcium levels) may occur after thyroid and parathyroid surgery because the parathyroid glands may not function normally right after surgery and temporary hypocalcemia/hypoparathyroidism is common. The parathyroid glands are four small, delicate glands that measure about the size of a grain of rice. They are located near, or attached to, the thyroid gland and control the blood calcium levels. Each thyroid lobe has two parathyroid glands. After thyroid surgery and before you are discharged home your blood calcium will be checked. You will also be sent home with instructions to take supplemental calcium for the first week or two weeks after thyroid surgery. Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet) as well as muscle cramps. At your first post-operative visit, your blood calcium level will be checked and you may be weaned off the supplemental calcium prescribed after your surgery. Only one half functioning parathyroid gland is needed for calcium control. If all four parathyroid glands were injured or removed during surgery, the blood calcium levels can become lower than normal.
- Seromas
Seromas are fluid collections underneath the skin at an incision site that feel like fullness or swelling. When minor, they get usually disappear within a few weeks. If the seroma is large, it may need to drained by a surgeon.
- Infection
If a post-operative infection develops, drainage of the infected fluid may be needed and antibiotics may be necessary. The neck is a clean area and generally does not get infected.
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What happens to your body after thyroid removal?
Following surgery, you may experience: Voice changes, such as, a hoarse voice, difficulty in speaking loudly, voice fatigue, and a change in the tone of your voice. You may experience low blood calcium levels due to damage to the parathyroid glands during surgery.
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What should I watch after thyroidectomy?
People who have a total thyroidectomy and most people who have a subtotal thyroidectomy will need to take thyroid replacement drugs (thyroxine) for the rest of their lives. Without this thyroid hormone replacement, people experience tiredness, depression, difficulty concentrating, memory problems, unexplained or excessive weight gain, dry skin, coarse and/or itchy skin, dry hair, hair loss, feeling cold (especially in the feet and hands), constipation, muscle cramps, joint pains, increased menstrual flow, low sex drive, and more frequent periods. The hormone replacement tablets are small and easy to take. Your doctor will check your hormone levels on a regular basis and adjust the dose of thyroxine until it is right for you.
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What nerve can be damaged during thyroidectomy?
Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery.
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After Thyroidectomy
A thyroidectomy is a major operation and you should rest for 2-3 days when you get home. You will normally be well enough to return to work in 1-2 weeks, but this will vary depending on the type of work you do. It is normal to feel tired for the first few weeks.
After surgery, you're moved to a recovery room where the health care team monitors your recovery from the surgery and anesthesia. Once you're fully conscious, you'll be moved to a hospital room.
Some people may need to have a drain placed under the incision in the neck. This drain is usually removed the morning after surgery.
After thyroidectomy, a few people may experience neck pain and a hoarse or weak voice. This doesn't necessarily mean there's permanent damage to the nerve that controls the vocal cords. These symptoms are often short-term and may be due to irritation from the breathing tube that's inserted into the windpipe during surgery, or be a result of nerve irritation caused by the surgery.
You'll be able to eat and drink as usual after surgery. Depending on the type of surgery you had, you may be able to go home the day of your procedure or your doctor may recommend that you stay overnight in the hospital.
When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing anything vigorous, such as heavy lifting or strenuous sports.
It takes up to a year for the scar from surgery to fade. Your doctor may recommend using sunscreen to help minimize the scar from being noticeable.