Thyroidectomy complications

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.


10 common questions about Thyroidectomy complications

1Is hoarseness normal after thyroidectomy?
OBJECTIVE: Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN).
2How long does it take for vocal cords to heal after thyroid surgery?
Around 4-6 weeks after surgery, when your incision is feeling firm (part of normal tissue healing), the muscles and other tissues around your larynx will often tighten and make your voice feel constrained during that time period. Most people regain their normal vocal function without any extra effort or thought
3Are the parathyroid glands removed with a thyroidectomy?
Thyroidectomy: surgery to remove the entire thyroid gland. ... Hypoparathyroidism — low calcium levels due to decreased secretion of parathyroid hormone (PTH) from the parathyroid glands next to the thyroid. This can occur as a result of damage to the glands during thyroid surgery and usually resolves.
4Can you die from having your thyroid removed?
Although very uncommon, death may occur after thyroid resection. ... The median time from surgery to death was 14 days (range 1-85). CONCLUSIONS: Death after thyroidectomy is very uncommon, and most often results from a combination of advanced age, giant goiters, and upper airway complications
5How long does hoarseness last after thyroidectomy?
The temporary problem usually occurs because one or more of the nerves are irritated either by moving them out of the way during the operation or because of the inflammation that happens after the surgery. Although the voice usually improves in the first few weeks after surgery, it can last up to 6 months
6How much swelling is normal after thyroidectomy?
You will see swelling or bruising develop in the area around the incision 1-3 days after surgery. You may also notice swelling, firmness, a pulling sensation, or even some trouble swallowing. This often increases over the first 1-2 weeks and then begins to resolve over 6-8 weeks. These are normal sensations
7Can you live a normal life after thyroidectomy?
In most cases, these supplements can be stopped within several weeks, once the parathyroid glands heal and their normal function returns. Patients require lifetime thyroid hormone replacement when the entire thyroid gland (both lobes) is removed, and sometimes when even just one lobe is removed.
8Is partial thyroidectomy major surgery?
In a partial thyroidectomy, only the cancerous thyroid lobe is removed. This surgery typically takes 1.5 to 2 hours to perform. Unlike a total thyroidectomy, this procedure won't result in hypothyroidism. Though one lobe is removed, the remaining lobe can still produce healthy amounts of thyroid hormone
9Can I talk after thyroidectomy?
The doctor may also remove the gland if you have an enlarged thyroid that is causing symptoms that bother you. ... Your doctor will take this out a few days after your surgery. You may have some trouble chewing and swallowing after you go home. Your voice probably will be hoarse, and you may have trouble talking.
10Do you gain weight after thyroid removal?
Losing weight can be a frustrating process for many people with an underactive thyroid. Whether you have hypothyroidism or no thyroid after surgery or radioactive iodine (RAI) treatment, there's no question that for many, the thyroid affects metabolism and can make weight loss an uphill battle.

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