Thyroidectomy: What to Expect
You're probably wondering what to expect after your thyroidectomy. The good news is, there is life after thyroid removal. Your recovery period should be fairly short. The bad news? Nobody can tell you exactly what to expect after your thyroid operation because each person will experience a different recovery time, as well as their own post-thyroidectomy symptoms.
Thyroidectomy: What to Expect
I have seen thyroid patients be up and moving within a few hours after surgery, and some don't want to move for a week! It depends on too many factors to have set-in-stone expectations, so the first thing to do when you're heading in for surgery is: focus on the positive.
Let go of any expectations you may have had, don't push yourself too hard, and stay positive.
Partial vs Full Thyroidectomy
A thyroidectomy is when all or part of the thyroid gland is removed, while a partial thyroidectomy or lobectomy is when one of the two lobes of your thyroid is removed. If you had thyroid cancer and it has spread, lymph nodes in the neck area may be taken out, too. I had my entire thyroid and a few lymph nodes removed during my surgery.
The reason you had your thyroidectomy in the first place is going to have a lot to do with whether you get a full or partial thyroidectomy. My thyroidectomy was due to thyroid cancer, but it was only seen on one side of my thyroid so the surgeon gave me the option of a partial or full thyroidectomy. The issue we saw with a partial was that my thyroid was already not working, so what was the point of keeping half of it? And what if I got cancer again? I didn't want any more surgeries than necessary, as I already had a tumor on my parotid that would also need surgery (will happen late 2019).
If you have a large tumor, a total thyroidectomy will likely be recommended, whereas if you have a small, non-aggressive tumor that's contained to one side, you can probably just have that side removed. Speak with your surgeon before making a decision because there are pros and cons to each.
The recovery for a partial thyroidectomy vs a full thyroidectomy isn't a whole lot different. Either way, you've had your neck sliced open and you're missing at least half of your thyroid.
Here's a longer post about my experience: Thyroidectomy Recovery (Week 1)
Length of Hospital Stay
I stayed 24 hours after my thyroidectomy. Some patients are able to go home the same day after 4-8 hours in the recovery room, depending on the extent and timing of the surgery. If staying 24 hours is an option, I highly recommend it.
While in the hospital, you'll drink liquids (I threw up the blue raspberry frozen whatever they gave me) and eat bland foods (yay, chicken noodle soup!), and pray you can keep it all down. Once you get home, you may feel like continuing the soft diet for a few more days.
Getting enough rest, eating well, drinking fluids, and walking will all go a long way in your recovery.
Pain from Thyroidectomy
I won't say the thyroidectomy and following weeks weren't pretty painful and/or uncomfortable, but I didn't take pain medications so it wasn't like I was DYING or curled up in a ball in pain. Yes, it hurt, but it wasn't unbearable. My ice pack was my best friend.
Your throat may be sore for a while; the soreness lasted a few weeks for me. My neck was a bit stiff but it wasn't awful. You may experience pain when swallowing, soreness in your neck, and even some swelling. This is all normal and should go away before your 1-month check-up.
Post-Thyroid Calcium Issues
Calcium is something I didn't think about until I saw it mentioned several times in the thyroid support groups I'm in, but it is important to monitor. Low blood calcium can be caused by the removal of the parathyroid glands. If your calcium is too high, it's called hypercalcemia; too low is called hypocalcemia. Both can be dangerous.
Hypocalcemia is a major post-operative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time. (Source)
Immediately following surgery, your surgeon may put you on calcium pills. These pills are huge, and not fun to take… but they are necessary at first. After a few weeks, you should be able to taper off of the calcium pills. I stayed on a high dose of calcium for a few months, which then began to cause problems. The issue is, hypocalcemia and hypercalcemia can have similar symptoms.
Signs of Hypercalcemia
— Loss of appetite
— Nausea and vomiting
— Constipation and abdominal pain
— Increased thirst and frequent urination
— Fatigue, weakness, and muscle pain
— Confusion, disorientation, and difficulty thinking
In my situation, my calcium was too high (hyper), yet the symptoms I had matched both low and high calcium. My appetite was minimal, I was nauseous constantly, I was easily confused, and had zero strength (all symptoms of hypercalemia). More bothersome to me was the constant tingling in my hands and feet, along with muscle cramps. Those suckers hurt! I have a naturally slow heartbeat, so that wasn't concerning in and of itself, but that is a symptom of hypocalcemia so keep an eye out if yours seems slow.
My surgeon kept me on the calcium thinking maybe it was too low (while we waited for lab results), but when I went to my endocrinologist, she said my calcium was too high so she discontinued it completely. I still have some tingling and cramping in my hands and feet but it's not as often. I'm still nauseous but it's not 24/7, it's more like “only” 60% of the time.
Signs of Hypocalcemia
— numbness and/or tingling of the hands, feet, or lips
— muscle cramps and/or spasms
— facial twitching
— muscle weakness
— slow heartbeat
If you have any of the symptoms listed in either section above, it's time to call your doctor and ask for some lab work.
Post thyroidectomy, your surgeon will prescribe thyroid hormone replacement medicine to replace the thyroid hormones. You will need this medication the rest of your life, and you will most likely need a few medication changes over the coming months and years. It's important to continually get your levels tested.
Synthroid is the most common medicine prescribed for thyroid issues. It's dosed in tablets that range from 25 to 300 mcg in strength and is usually taken once a day with a full glass of water 60 minutes before breakfast for best adsorption into the body. None of my doctors told me to take it with a full glass of water, OR to wait 60 minutes before eating for best absorption. I learned this by doing research online so I wanted to share that tidbit with you as well.
Synthroid (levothyroxine sodium) is a synthetic compound identical to T4 (levothyroxine) produced by the human thyroid gland used to treat hypothyroidism due to thyroid removal, thyroid atrophy, functional T4 deficiency, and more.
Synthroid can cause side effects, including hot flashes, sensitivity to heat, sweating, headaches, nervousness, irritability, nausea, sleep problems, changes in appetite and/or weight, and temporary hair loss. Unfortunately, these symptoms are also things that may show up with thyroid issues or after a thyroidectomy, or if your Synthroid dose is off. This makes it difficult to figure things out, because it's all trial and error.
Side Effects of No Thyroid
Now your thyroid is gone, you may feel like you're on an emotional roller coaster. One minute you're laughing and having a great time, the next minute you're so pissed off you are seeing red – or, maybe today you're just sad. Yep, here come the tears again. It happens.
It's hot. It's cold. You're in and out of the arctic tundra, all the way to the sweltering rain forest. Your body's thermostat may seem broken. I experience hot flashes and, well, cold flashes, for lack of a better term… all day long.
My hands tingle often and my feet cramp every night, even when my calcium and potassium levels are “perfect”.
All of these things may not be permanent, but for now it's the “new normal”. You'll probably hear that phrase a lot while dealing with your post-thyroidectomy symptoms.
Your Voice After Thyroidectomy
Voice changes such as a hoarse voice, difficulty in speaking loudly, voice fatigue, and a change in the tone of your voice are to be expected after a thyroidectomy. These changes are due to damage to the laryngeal nerves that supply your voice box during surgery. This may last a few days or a few weeks but is rarely permanent.
However, I'm 3 months post-op and my voice is still nothing like it used to be. It's difficult to sing, I can't yell, and my voice tires out very easily. I used to speak at conferences and sometimes had to speak for hours at a time. I can only speak for about 15 minutes now without getting tired. I also find I need to drink water more often while speaking.
Losing Weight After Thyroidectomy
I gained about 18 pounds in the few months following my thyroidectomy. I ate less because I was nauseous constantly, yet I still gained weight. About 3 months after my surgery, my medications were switched. I immediately lost 5 pounds within the next two weeks! It's amazing what the right dose of thyroid medications will do for your health and wellness.
My limited experience without a thyroid has not made me an expert on weight loss with thyroid issues by any means, but I've read hundreds of posts in the thyroid cancer support groups I'm in and I've learned a few tips. To lose weight after a thyroidectomy, focus on reducing your carb and sugar intake. Keep a food diary, and get up and move.
Life After Thyroidectomy
I chose to get my thyroidectomy the week after my husband and I got married. Yes, I had thyroid cancer and they wanted it out ASAP, but it's a slow-growing cancer and I didn't want to worry about a scar on my wedding day. Looking back on it, it sounds even more superficial now than it did then – especially because my scar is almost invisible and wouldn't have shown up in the photos. However, I liked having the peace of mind of wedding planning before surgery. I didn't have the energy for it after surgery!
You may be exhausted after surgery, and that feeling may not go away for quite some time. I'm a few months out and I'm still tired. I'm just now starting to feel better, but I'm still tired quite often. Getting meds situated after a thyroidectomy can be a roller coaster. Be patient with yourself, and with the process. Enjoy life and don't let this – or anything else – stand in your way of living your best life.
One last note I'll leave you with:
Always take your thyroid meds, and get your levels checked every 3-6 months. Get a thyroid blood test to make sure your thyroid levels are normal. If they're off, you may experience uncomfortable symptoms – much like before your thyroidectomy.