Total Thyroidectomy means removing the complete thyroid gland. It can be due to different reasons. After a total thyroidectomy patients should follow the below instructions to get maximum benefits.
1. Medication Management
Due to the removal of the thyroid gland thyroid function is lost. Thyroid hormone production is lost. Because of that thyroid hormone should be taken outside. It is considered as HRT ( Hormone Replacement Therapy)
Thyroid Hormone Replacement: Take prescribed thyroid hormone replacement (levothyroxine) as directed to maintain normal hormone levels.
During total thyroidectomy, parathyroid glands can be removed. Most of the time it can be preserved. Sometimes gland is preserved. But blood supply is impaired. This leads to impaired parathyroid functions. Calcium and vitamin D supplements need to be taken permanently or until the conformation of the parathyroid is working.
Calcium/Vitamin D Supplements: If part or all of the parathyroid glands are affected, you might need calcium and vitamin D supplements to prevent hypocalcemia (low calcium levels). Watch for symptoms like numbness, tingling, or muscle cramps and inform your doctor if they occur. Numbness around the mouth and fingertips is the most common symptom.
2. Wound Care
Keep the incision clean and dry. If your plaster dressing is waterproof you have a bath on next day.
Gently wash the area with soap and water after removing the dressing. Dressing removal time is dependent on the surgery. Avoid scrubbing or applying ointments unless prescribed.
Avoid exposing the incision to direct sunlight to prevent noticeable scarring.
3. Activity Restrictions
Avoid strenuous activities, heavy lifting, or neck movements that strain the surgical area for at least 1-2 weeks.
Gradually resume normal activities as per your doctor’s advice.
4. Pain Management
Take prescribed pain medications as needed. Over-the-counter pain relievers like acetaminophen or ibuprofen may also be used if approved by your doctor. Some discomfort in the throat and neck is normal, but severe pain should be reported.
5. Monitoring for Complications
• Signs of Low Calcium:
Tingling in the hands, feet, or around the mouth, or muscle spasms (these may indicate hypocalcemia).
• Voice Changes or Difficulty Speaking:
This could suggest irritation to the recurrent laryngeal nerve during surgery.
• Swelling or Bleeding:
Sudden swelling in the neck or difficulty breathing may require immediate medical attention.
6. Dietary Recommendations
Begin with soft foods if swallowing is uncomfortable. Stay hydrated and avoid very hot, spicy, or hard foods that may irritate the throat.
7. Follow-Up Appointments
Attend follow-up appointments for lab tests to monitor thyroid hormone and calcium levels.
You need to do the TSH (Thyroid Stimulating Hormone ) levels to decide on thyroxine dose.
Scar assessment and further adjustments to your medication dose may also be addressed.
Trace your histology report for your removed thyroid gland. It can confirm whether it is cancer or not.
8. Lifestyle Adjustments
Regularly monitor thyroid function as this will be necessary for the rest of your life. Be aware of symptoms of hypothyroidism (fatigue, weight gain, cold sensitivity) or hyperthyroidism (nervousness, weight loss, palpitations).
9. Emotional Health
It’s normal to feel anxious or emotional post-surgery. Seek support from family, friends, or professionals if needed.
FAQs
General Recovery
1. How long will it take to recover?
Most patients recover within 1-2 weeks, though fatigue and mild discomfort may persist for a few weeks. Full recovery, including returning to normal activities, usually takes about 4-6 weeks.
2. When can I return to work or normal activities?
You can typically return to light work or activities within 1-2 weeks. For physically demanding jobs, wait at least 4 weeks or as advised by your surgeon.
3. Is it normal to feel tired after surgery?
Yes, fatigue is common due to the stress of surgery and changes in hormone levels. It improves as you recover and your thyroid medication is adjusted.
4. When can I resume exercise or physical activity?
Light activities like walking can be resumed within a few days, but avoid strenuous activities, heavy lifting, or neck strain for at least 2-4 weeks.
Wound Care
5. How should I take care of the incision site?
Keep the incision clean and dry. Wash gently with soap and water after 48-72 hours, unless otherwise instructed. Avoid applying creams or ointments unless prescribed.
6. When can I shower or wash the surgical area?
You can typically shower 48-72 hours after surgery, but avoid submerging the incision in water (e.g., baths or swimming) for at least 1-2 weeks.
7. Will there be scarring, and how can I minimize it?
A scar is normal but will fade over time. To minimize scarring, keep the area moisturized with a doctor-approved cream and protect it from direct sunlight by using sunscreen.
8. What should I do if the incision becomes red, swollen, or painful?
These could be signs of infection. Contact your doctor immediately if redness, swelling, or pain worsens or if you notice pus or fever.
Pain and Discomfort
9. What kind of pain or discomfort is normal after surgery?
Mild pain around the neck and incision site, as well as a sore throat, is normal. Some patients may experience stiffness in the neck muscles.
10. How long will throat pain or hoarseness last?
Throat pain and hoarseness typically improve within 1-2 weeks. Persistent issues may require follow-up with your doctor.
11. What medications can I take for pain?
Use prescribed pain medications or over-the-counter options like acetaminophen or ibuprofen, unless contraindicated.
Calcium and Parathyroid Issues
12. Why am I feeling tingling or numbness in my hands, feet, or face?
This could be a sign of low calcium levels (hypocalcemia), which can occur if the parathyroid glands are affected. Contact your doctor immediately.
13. Do I need to take calcium or vitamin D supplements?
Many patients need calcium and vitamin D supplements temporarily or long-term. Follow your doctor’s instructions based on your lab results.
14. How long will I need supplements, and can I stop taking them?
Some patients take supplements for a few weeks, while others may need them long-term. Your doctor will decide based on calcium and parathyroid function.
Thyroid Hormone Replacement
15. When will I start thyroid hormone replacement therapy?
Thyroid hormone replacement (levothyroxine) is usually started the day after surgery or soon after.
16. How should I take my thyroid hormone medication?
Take it on an empty stomach, at least 30-60 minutes before breakfast, with water. Avoid taking calcium, iron, or antacids within 4 hours of your dose.
17. What happens if I miss a dose of my medication?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose—never double up.
18. How often will my thyroid hormone levels be checked?
Your levels will typically be checked 6-8 weeks after surgery, then periodically until the dose is stabilized.
19. Will I need thyroid medication for the rest of my life?
Yes, since the thyroid is removed, lifelong thyroid hormone replacement is required.
Potential Complications
20. Is it normal to have voice changes or hoarseness after surgery?
Yes, temporary hoarseness or voice changes are common due to irritation of the vocal cords or nerves. If it persists beyond a few weeks, consult your doctor.
21. What are the signs of complications, such as infection or bleeding?
Signs include fever, redness/swelling at the incision site, increasing neck pain, difficulty swallowing, or sudden swelling. Seek immediate medical attention for difficulty breathing.
22. What should I do if I feel difficulty breathing or have sudden neck swelling?
Call emergency services or go to the hospital immediately, as this could indicate a serious complication like bleeding.
23. When should I call my doctor?
Call your doctor if you experience worsening pain, fever, signs of infection, severe tingling, muscle spasms, or persistent voice changes.
Diet and Lifestyle
24. Are there any dietary restrictions I need to follow?
No specific restrictions, but start with soft foods if swallowing is uncomfortable. Avoid foods that irritate your throat.
25. Can I eat normally, or should I stick to soft foods?
You can eat normally once comfortable, but soft foods may be easier in the first few days.
26. How much water or fluids should I drink?
Stay hydrated with 6-8 glasses of water daily unless advised otherwise.
27. Can I drink alcohol or caffeinated beverages?
Limit alcohol and caffeine immediately after surgery, as they can dehydrate you and interfere with recovery.
Follow-up and Long-Term Care
28. When is my first follow-up appointment?
Your first follow-up is usually scheduled 1-2 weeks after surgery to check the incision and discuss lab results.
29. How often will I need check-ups in the future?
Initially, you may need blood tests every 6-8 weeks to adjust your medication. Once stable, check-ups occur every 6-12 months.
30. What signs should I watch for to know if my thyroid hormone dose needs adjustment?
Watch for symptoms like fatigue, weight changes, hair loss, cold/heat intolerance, or mood changes, and inform your doctor if they occur.