Thyroidectomy, the Solution for many Thyroid Diseases
Lets explain thyroidectomy surgery procedure steps types Scars Diet & Recovery complications in near subtotal, total and partial thyroidectomy.
Thyroidectomy is very well-known as the surgery involved in the thyroid gland. The thyroidectomy recovery process is not so complex; it just requires some special care and precautions. This surgery requires special care afterward.
The diet, dos and don’ts and many other medications are required to heal up from the side effects of thyroidectomy. Here you will come to know about that. Also, we will discuss the steps involved in the thyroidectomy and the period of recovery.
But we need to know first, what the cause of thyroid surgery and what all is thyroidectomy is.
What is Thyroidectomy?
The thyroid gland is one of the most vital organs in the body. It secretes the thyroid hormone, which is an essential hormone for the metabolism and various other mechanisms in the body. But when the thyroid gland suffers any disorder due to hormonal imbalance or some serious disease like cancer, then the gland gets severely infected and needs a surgery.
“The surgery of the thyroid gland that involves the removal of the gland is known as Thyroidectomy. This is a technique that helps in curing various thyroid-related disorders, like thyroid cancer, goiter, hyperthyroidism and also hypothyroidism, etc.”
The portion of the thyroid gland removed during the surgery defines the different types of Thyroidectomy. When the complete thyroid gland is removed, it is Total thyroidectomy, and when a small portion of the thyroid gland is removed is known to be Partial thyroidectomy. What are the types of thyroidectomy? Let’s have a look.
Types of Thyroidectomy
Subtotal Thyroidectomy: in this type, the whole of the gland is removed and just a small portion is left. This is the most common operation that takes place during multinodular goiter. Around 4-5 grams of the thyroid section is left after subtotal thyroidectomy.
It requires thyroid hormone therapy for a few months.
Partial Thyroidectomy: when a section of the gland is removed, it is partial thyroidectomy. In this type, the portion of the gland in front of the trachea is removed. Only one lobe is generally extracted which is infected in case of partial thyroidectomy, and rest healthy lobe is left as it is.
This thyroidectomy does not require thyroid hormone therapy for a long time because the other left lobe continues its function of the hormone production.
Near Total Thyroidectomy: When in thyroidectomy both the lobes are removed and just a minimal amount of thyroid tissue in the site of recurrent laryngeal nerve and superior parathyroids. The left part maybe 1.0 ml of thyroid tissue only in near-total thyroidectomy.
It requires quite a long-term of thyroid hormone replacement therapy.
Total Thyroidectomy: When the entire thyroid gland is removed and nothing is left back, then it is known to be the total Thyroidectomy. It is most common in the different types of thyroid cancers and goiter too.
This leads to almost the lifetime thyroid hormone replacement therapy, which balances the level of thyroid hormone in the body of the patient, maintaining the proper mechanism and metabolism in the body.
What can be the complications of thyroidectomy?
- The biggest complication is the max chances of the having hypothyroidism after the surgery. Yes! This is because of the thyroid gland removal, Thyroidectomy leads to scarcity of the thyroid hormone production, thus causing a underactive thyroid gland or Hypothyroidism.
- There occurs laryngeal nerve injury in most of the surgeries of the thyroid gland. It can result into voice damage or a hoarse voice. In some cases of the surgery, a surgical emergency or an urgent tracheostomy may also be needed.
- It may also follow anesthetic complications
- The thyroidectomy can also cause infection, an increased risk with chronic pre-operative steroid use.
- A hemorrhage or hematoma, during the surgery, may compress the airway. It becomes life-threatening.
- There can also be a permanent scar on the throat of the patient who has undergone a surgery of the thyroid gland.
- After thyroidectomy, the biggest complications expected is the Nerve Palsy. It happens because of the nerve injury during the surgery.
- At times the goiter may reappear, which again demands a thyroidectomy. This surgery is far more complicated than the first one, and maybe more dangerous. The reason is the scar in thyroid tissue makes it difficult to recognize the nerves and other crucial parts.
The thyroid surgery leaves a tough scar on the front portion of the neck. The length of thyroidectomy scar varies depending on the physique of the patient and the size of the gland in the patient’s body. The size of this scar can be an inch to three inches.
In case of thyroid cancer, the incision is made larger. There are some easy ways to remove the thyroidectomy scar. It may take days to months to get the scar disappear. The doctors themselves recommend ointments to remove the scar after surgery.
The thyroidectomy scar should heal up in a couple of weeks or more. You also need to take good care of the incision made after the surgery. It is prone to infections too.
There are some good ways to take care of the wound that can help:
- Take care of proper hygiene of the wound; as if it creates any infection can also lead to tetanus.
- Keep it dry, don’t let the water or moisture capture in. As it can increase the risk of infection.
- Keep changing the dressing or bandage of the wound only under doctor’s supervision. The reason is old dressing may be covered with dirt, and can also cause severe infection in the throat.
- Help the healing by following the diet suggested during thyroidectomy. Take a properly balanced diet, rich in calcium, zinc, and selenium.
- Stay away from smoking. Tobacco aggravates the problem and can cause thyroid cancer or lung cancer in the future.
- Limit the neck movement. Too much of neck movement, rotation or stretching may cause the wound to bleed again or break the stitches.
- Take the painkillers or ointments only of doctor’s prescription.
These tips will help the healing of the neck wound soon and help the scar disappear as well.
Near Total Thyroidectomy
What is the Near Total Thyroidectomy? What are the after effects of this surgery?
The Near Total Thyroidectomy is the removal of the nearly complete thyroid gland, except for some thyroid tissue, which is least affected by the disease. This requires a lifetime thyroid hormone replacement therapy.
It is mostly for the thyroid glands affected by cancer, or multinodular goiter. The Graves’ disease is also treated by near-total thyroidectomy. The left portion during the surgery is approx. 1.0 ml or little more.
The risk, in this case, is nil and the cure rate is no doubt very high in this case. But very rare it happens that if the left small portion has some cancerous cells left then it may prove fatal for the body.
The related complications of near-total thyroidectomy are:
- Thyroidectomy scar
- Nerve palsy or nerve injury
- Destruction of healthy tissues
Subtotal thyroidectomy is a type of surgery of the thyroid gland in which a small section of the thyroid gland is left and rest is removed which is infected of any serious disorder.
The least infected or the healthy part of the thyroid gland is only left during surgery so that the thyroid hormone production continues and there is no lifetime thyroid hormone replacement therapy required in future.
The patients with Graves’ disease and Hashimoto’s disease with thyroiditis, and thyroid cancer and adenoma require Subtotal Thyroidectomy.
Prior to the surgery, an anti-thyroid medicine is given to the patient. In most of the cases nowadays 2 to 3 surgeons undergo subtotal thyroidectomy. Till 20th century only one surgeon was being used for it.
It can lead to voice damage, leading to hoarse voice and some tissue damage in the thyroid gland, due to the surgery. Still, the cure rate of subtotal thyroidectomy is pretty high and never fatal.
The removal of the half of the part of the thyroid gland is known as Partial Thyroidectomy. The thyroid still remains functional in this type of surgery.
Within 24 hours of the surgery, calcium assay is performed to check calcium deficiency after the partial thyroidectomy. Else calcium supplements of 1500 to 3000 mg of elemental calcium may be started if the deficiency is observed. Apart from the thyroidectomy scar, the laryngeal injury can also be caused.
Similarly, it may cause voice hoarseness due to the surgery. The hoarse voice is can be for a short period or longer one. The destruction of laryngeal nerve or one of the vocal cord due to the incision may cause a longer time to heal.
Partial thyroidectomy is useful in case of Papillary carcinoma, Thyroid Adenoma and other types of thyroid cancer. Its cure rate is pretty high with an excellent prognosis. Just the fear comes when there is any cancer cell in the thyroid gland, which may further damage the gland.
The thyroidectomy that involves the use of endoscopy is termed as Laparoscopic thyroidectomy. It is the Scarless Endoscopic Thyroidectomy, another name to it, to avoid the wound in the neck and let the normal appearance stay.
Here the operating equipment uses the endoscope along with it during operation. The equipment for laparoscopic thyroidectomy are used in the same way as it is in normal thyroidectomy cases, but here endoscopic instruments are also an additional use.
A good example is the treatment of a 21-year-old girl, in the year 2005 who was having a lump in her neck and she was suffering from thyroid cancer. The surgery for thyroid cancer was the only solution to remove the cancer part. But the issue was the incision and the thyroidectomy scar after surgery.
Dr. Sandeep Nayak, one of the leading surgical oncologist from Bangalore gave the laparoscopic treatment to this girl. He is famous for giving the scarless endoscopic treatment or laparoscopic treatment in India.
He said in an interview, “This girl was the best candidate for Laparoscopic Thyroidectomy. She was getting married, but as suffering from thyroid cancer she was afraid of the scar after the neck surgery. During the surgery, we first removed her thyroid nodules and the removal took place leaving no scar behind after the surgery.”
He has got many rewards for his pioneer contributions in the field of Laparoscopic Thyroidectomy in India.
There are many types of thyroidectomy; the Endoscopic Thyroidectomy is the one. Well among them, it is the one not much in practice. This type of thyroidectomy is a very useful one in the cases of multinodular goiter and papillary carcinoma, as it can clean away all the infection.
It helps in removing the large thyroid nodules as well, without any damage to the thyroid gland. Only the expert surgeons can practice the endoscopic thyroidectomy.
The endoscopic thyroidectomy actually uses endoscopic instruments at the time of operation. More than two surgeons or sometimes 5 surgeons come into the process during this thyroidectomy. The surgeries during a subtotal thyroidectomy or near-total thyroidectomy use the endoscopy.
The cure rate is very high in this case and also less painful. The benefit of endoscopic thyroidectomy is no damage to the laryngeal nerve or any other healthy section of the gland, and the superior and inferior parathyroids are also identified and turned safe and undamaged.
The cosmetic results in the endoscopic thyroidectomy are also satisfactory. As they may easily remove thyroidectomy scar in a short span, and some techniques are to enhance the scarless endoscopic thyroidectomy, where no scar is left behind.
What are the steps involved in thyroidectomy process?
The thyroidectomy involves following steps:
The first step is the incision of two finger breadth is made in front of the neck, or V-shape. The width depends on the lump or nodule size in the thyroid gland.
The dissection on the thyroid cartilage
A triangular incision for the surgery is drawn and a dissection is made at the level of the thyroid cartilage and the notch of the gland.
Separation of the gland muscles and the anterior part of the gland gets exposed
The muscles between the thyroid straps are divided so that the gland appears with its anterior part.
Identification of the Thyroid vein
This step allows the gland to be free and movable; so that the lump can be removed easily.
Identifying the Laryngeal Nerve and the nerve endings
It is one of the most crucial steps, because if not done carefully it may damage the laryngeal nerve during the operation. In some cases, the superior laryngeal nerve branch lies on the anterior surface only.
Identification of the Superior and Interior Parathyroid glands and the Recurrent Laryngeal Nerve
This point is also very important, to avoid any damage. As it may cause serious ramifications afterward.
Division of the Thyroid Isthmus
Now to do the lobectomy, first, the isthmus is divided crossing between the two lobes of the thyroid gland.
Removal of the Thyroid Gland
Finally, the gland or its infected section is removed very carefully, through proper equipment. Now, the operation of thyroidectomy is complete.
Thyroidectomy Recovery Process
Following the surgery, a proper recovery process should be followed. The patient is moved to the recovery room, for a few days till the patient starts becoming conscious, healing from his wound and other complications.
- The recovery from the surgery and anesthesia are observed under several monitors to take proper care of the patient. Once the patient becomes conscious, he is transferred to the normal hospital room. It may take days to weeks.
- The problems after the thyroidectomy are a pain in the neck and hoarse voice. There are still rare cases of permanent damage in the voice, but if it happens the cause may be the nerve damage.
- After the proper recovery, the patient is able to eat and drink normally as he used to. But everything is under the doctor’s watch.
- After the discharge, recovery still goes on. So, the patient should avoid any vigorous type of work and keep a proper balance.
- A regular visit to the doctor is advised for a few months, depending upon the type of the thyroidectomy.
Weight Loss after Partial Thyroidectomy
Whether it is a partial or total thyroidectomy, the patients after the surgery always need a thyroid hormone replacement therapy. Hence, the doctors subscribe the low daily doses of T4 mostly to the patient.
Now, the problem of weight arises here only, because the T3 hormone helps in better metabolism; thus, the weight loss. While T4 is not that efficient in doing so. Either it has to convert the T4 into T3, so for that too thyroid gland needs to work actively, which is not possible after the surgery.
So, in order to lose weight or maintain your weight properly after the thyroidectomy, you will have to work harder and smarter. Therefore, you just need to follow a few steps that can help you in the long run.
Say no to drugs
Do not take drugs that help in weight loss. Keep working, the slow and steady wins the race.
Lose your weight not your mind
Lose your body fat, don’t undergo the blunders that you might be mistaken with weight loss techniques, like crash diet etc. Your body is sensitive after the thyroidectomy, so take a proper diet and follow proper exercise or fitness regime. Take help from your doctor too.
Drink plenty of water
Keeping yourself hydrated is the another best way to stay fit. Water speeds up the mechanisms the body undergoes.
Take more fiber in your diet
Take a diet which is balanced with all the nutrients and fibers as well. Fibers help lose your weight soon.
Doing Yoga and Exercise
Yoga and Exercise should be inherited in your daily routine. It helps lose weight properly in a good rhythm. Also, take help of your doctor and physiotherapist as they know your wound and sensitivities of the body.
These techniques might be helpful to you in order to lose weight and heal up naturally as well.
Subtotal and Partial Thyroidectomy side effects
There are many side effects after subtotal and partial thyroidectomy. They can be short-term basically and less serious and harmful.
The side effects are:
Persistent pain in the neck
There can be a persistent pain in the neck due to the surgery. It is because of the incision made. The solution is painkillers like Ibuprofen, etc.
Neck tenderness and discomfort
The tension in the neck after surgery is a common issue every patient complains about. The movement of the neck becomes tough and it becomes uncomfortable to rotate head or stretch.
Hoarseness of the voice
The other side effect of thyroidectomy is the hoarse voice due to the damage to the vocal cord nerves or larynx.
Trouble in swallowing food
Prior to the thyroidectomy, it was tough to swallow food due to the enlarged thyroid gland. Now, after the surgery, it has become tough to swallow food because of the wound in the neck and the incision made during surgery. It makes pretty uneasy to eat food properly.
An irritated windpipe
Thyroidectomy that used breathing tube during anesthesia can create a problem to the windpipe. It keeps the choked throat feeling for a few days.
Itching in the Neck
The itching in the neck can cause the problem. It happens after the surgery if any allergy jumps out. The itching should be avoided by the patient as it can aggravate the condition of the wound.
Foods to Avoid and Diet after Thyroidectomy
There is a lot to take care during and after the thyroidectomy. Similar comes to the diet after the surgery of a patient. Let’s have a look on what food to eat after surgery and what not.
First, we will discuss what food the patients should have?
- After the surgery, liquid food or soft foods are the best. They include water, juice, puddings, milkshakes, mashed vegetables, and potatoes etc.
- Non-veg as, fish, meat, boiled eggs are also good to put in your diet.
- Drink lots of water, to keep you hydrated. You may take juice and soups frequently.
- Eat slowly. Mash all the food you eat.
- Include milk, milk products (mashed up), or protein shakes in your diet.
- To relieve your wound you can try ice creams as well, but take care you don’t get a cough.
- Eat food containing vitamin C, it is helpful in healing. Foods like oranges, tomato juice, and soups, raspberries, strawberries, are good for health at this time are good after recovery from thyroidectomy.
- After recovery from thyroidectomy, you can also have a good amount of green vegetables and pulses. Spinach is the best.
- Watermelon is a great help in healing.
- Foods like chicken, beef, and pork are high-protein resources. They are also rich in zinc. Zinc is also required at the time of healing for the body.
- Along with this, food rich in iodine, like seafood, fish, fish cod oil, etc. are good to avoid any further thyroid problem.
- Along with this for a proper functioning of the thyroid gland, Selenium supplements should also be taken regularly for a few months. Calcium is also high in need for the body to keep the bones and muscles work well.
What should you not eat after thyroidectomy?
If you have suffered the surgery due to hyperthyroidism, please note, “do not take Iodine-rich food”. Avoid it the most.
- Avoid having white bread and pasta. Brown bread is a better option.
- Do not take alcohol or smoke. It’s disastrous to health.
- Taking in drugs to reduce weight is the most harmful thing to your health. Keep calm, and work slowly and consistently on it.
- Also, avoid chocolates and caffeine products if you actually want to heal up soon.
- Avoid eating the junk foods and oily and spicy foods if you have been through thyroidectomy.
I hope this would be enough to understand the diet during and after thyroidectomy in the patient.
How is Life after Partial Thyroidectomy?
Partial thyroidectomy becomes a tough part for those who face it. That too leaving a scar for life.
The patients face various repercussions right after the surgery. First, they start losing somewhat of their confidence because of the visible scar. Though there are many solutions to remove it, in some cases it doesn’t fade out easily.
Next possible consequence is the effect of the anesthesia. Only some are there who can handle anesthesia well, else there are many harms of it on the body; that too prolonged ones. Anesthesia may cause a permanent migraine and nausea problem, and also an irritating windpipe.
Some more after effects
- The incision is more or less very difficult to overcome. Doctors may say that it would heal up soon, but if any if your nerve gets damaged then it’s not easy to heal up. The neck could not be rotated or move easily for months after the surgery.
- Sports or any other physical activities are not easy though even after many weeks.
- The weakness of the body also doesn’t go off easily.
- The stitches on the neck may also be painful. It may keep the movement of the whole head difficult. Though the incision is dissoluble, if not easily dissolved it becomes terrible to remove.
- In short, the patient may suffer a lot if the techniques are not properly organized.
- The diet of the patient becomes restricted. It begins with the liquid food, then soft food. Further, there are many restrictions on what to eat and what not, and this may continue for years after the thyroidectomy.
- The patient needs to get habitual to this diet. Thus, it is quite difficult for the patient to manage the thick and thins after thyroidectomy, still it is a crucial and a must do treatment. Your body may face many changes due to the surgery, and you may also face emotional stress.
One most important thing to remember is this surgery is for your good. Undergoing a surgery is not just your body’s need, but it will give you a new life too. It not just cures up your disease but helps you come out of the depression of the thyroid disease as well, be it cancer or a multinodular goiter.
Recovery from Partial Thyroidectomy
The partial thyroidectomy may take a minimum of 2 days to recover or it may also take a week or more. It depends on the surgical technique and the health of the person. The patient after the thyroidectomy may take time to get back his consciousness.
The recovery room is for the patient only; he shifts in that room after the operation. As soon as he becomes conscious he next goes into the normal room of the hospital.
Considering the medication, the thyroid hormone replacement therapy is given to the patient. It is a necessity in all types of thyroidectomy, but in case of partial thyroidectomy, the doctors recommend the hormonal therapy for just a few months.
As the thyroid gland is half left with a section, so as soon as it heals up from the thyroidectomy it starts working normally. Thus, the patient doesn’t require any thyroid hormone replacement therapy.
The diet for the patient starts with fluids and juices; some cold juices help in relaxing the neck wound due to the incision. A proper iodine-rich diet and supplements for calcium, selenium, and zinc are also given after the recovery, to make the thyroid gland healthy again.
Partial thyroidectomy scar gets the solution by the ointments, and the after surgery neck pain heals up slowly. The doctor prescribes the painkillers, tranquilizers, and ointments for this. The recovery may take time, but if you take proper precautions then you can gain speedy recovery.
Post-Operative Care for Thyroidectomy
Lots of care must be taken after thyroidectomy, which can make the body and the glands fit and healthy again. A proper care can only help in fast recovery. Let’s take a look, what the post-operative care for thyroidectomy is?
The diet and swallowing of food
The incision and the gland after surgery become very delicate so it is important to take good care. For that after the surgery, the doctor recommends liquid diet and soft food. Due to discomfort in swallowing, fluids are better in the beginning.
Post-surgery pain medicines
There remains a pain in the neck due to the surgery. The doctors give painkillers and antibiotics to relieve the neck pain and discomfort. The antibiotics are to keep the wound away from any infection.
Thyroid hormone therapy
The thyroid gland removal leads to the requirement of the synthetic form of thyroid hormone. If any surgery leaves a section or tissue, then it can help in thyroid hormone production. But, at the time of complete gland removal, the patient may need thyroid hormone replacement therapy.
The hospital pathology takes regular blood tests for thyroid level in equal intervals of days.
After the thyroidectomy, the calcium level drops. So, the doctor prescribes the calcium supplements to the patient. The calcium supplements help in the recovery of the weakness in the bones and muscles of the body.
The Radioactive Iodine Therapy
Thyroidectomy in case of thyroid cancer leads the radioactive iodine therapy. This therapy helps in killing the left cancer cells in the thyroid gland. Thus, the cancer cells are killed by high energy radiations during the radioactive iodine therapy.
This might require the thyroid hormone therapy after thyroidectomy to compensate the destruction of the healthy thyroid cells during the radiotherapy.
The care of the wound
The incision done during the thyroidectomy requires a proper care. It may cause pain in the neck, and redness and swell in the neck. The wound in the neck should be kept clean and dry. The patient must take care and keep the wound away from infection.
The infection through bacteria or fungus generally takes place in the moist areas in the wound after thyroidectomy. The wound heals in months. There are many ointments and painkillers available in the market that can help in the disappearance of the thyroidectomy scar and relieve the pain.
The patient may resume his normal activities in 4-5 days of the discharge from the hospital. Till then he recovers well. But he should not perform vigorous activities for a few more months. Such as exercise, jumping, swimming, moving up and down stairs or lifting heavy things.
“It is your body, listen to your body, when it is comfortable when it requires rest and do not exceed your limits.”
This post-operative care for thyroidectomy can be helpful to you or anyone in need.
How long does it take to recover from Thyroidectomy?
In case of most patients, walking and normal routines are presumably in 2-4 days after the surgery. But they need to avoid vigorous activities. What is the job type also defines how much they can take off from their work, but a good rest of 1-2 weeks is sufficient?
The incision during surgery leaves a scar, they may heal quite well if you take good care of it. Or may also take time after infection or retains moisture. Patients should avoid the exposure to sun and also avoid the use of cosmetics for a few months on the incision.
Keep a regular intake of Vitamin E it will help heal the wound faster. Coming into a normal routine, like taking a proper bath, walking, eating own self, reading and writing within a week after discharge.
The patient should avoid vigorous activity and heavy lifting up to 4-5 weeks. The proper medication will help in easy healing.
Some of the patients also feel sensation because the swelling or lump earlier to the surgery, which may also lead to discomfort in the neck, and trouble in swallowing the food. The voice may turn out to be hoarse, but it is not permanent. It is just because of the incision, but if the surgery leads to cut of laryngeal nerve it may cause a permanent damage to the voice of the patient.
The voice hoarseness gets treatment in 2-3 months of the surgery. The proper medication by the doctor will help maintain the voice on its proper level.
This is all about the thyroidectomy, which I feel can be helpful to the people who are in need; and increase your information on thyroidectomy as well.
Take good care of yourself and your family.
Stay hale and hearty always.