Thyroid and Parathyroid Surgery

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Before the operation:

2 weeks before the operation you should not take any non-steroidal anti-inflammatory medications.  These include Motrin, Ibuprofen (Advil), Aspirin, Naproxen or any medications containing these drugs.  All herbal medications should also be avoided as they can interfere with normal blood clotting and anesthetic agents.  If you take pills for high blood pressure, you should still take them the morning of surgery with sips of water.  One of the risks of the surgery is post operative bleeding which will be less likely if these instructions are adhered to.

Patients will attend a pre-operative tour at the hospital where blood work and pre-operative testing will be done if any has been ordered.  If this is not attended and we are unable to contact you to confirm that you are still going ahead with your surgery, it will be cancelled.

 

After the Operation:

You will be discharged 1-2 days following the surgery in most cases.  Some patients can be discharged home the same day of surgery, but all patients are seen the day following surgery to have any drains removed.  There is generally no drain placed for parathyroid surgery.  After thyroid or parathyroid surgery you should expect to have some small tapes over the incision to help reduce wound tension and result in a smaller finer scar.  You can remove these tapes 5 days after surgery by getting them wet in the bath or shower and peeling them off the neck.  The sutures are dissolvable and will not need to be removed.  It can be helpful to use Vitamin E or other prescribed cream, such as Fucidin, over the incision for up to  a month to aid in healing.  You don’t start the cream until the steri strips are removed. You can shower the day you go home but should have a Band-Aid over any drain sites.

If you develop significant swelling over the incision site, redness or difficulty breathing, you should contact the office or go to the nearest emergency room for treatment. Following parathyroid surgery you may experience paresthesias, or tingling, in the hands, feet or lips. If this persists you would need to go to the emergency department of contact the office to have your calcium and parathyroid hormone levels checked.  Patients can often have these symptoms temporarily from having the calcium level return to normal following surgery.  This tingling results from a temporary state of perceived excitement by your nervous system due to the lower level of calcium in your blood, and will be temporary.

In a patient who has had a total thyroidectomy, these symptoms need to be addressed by increasing oral calcium intake and possibly Rocaltrol, which is an active form of Vitamin D  prescribed by Dr. Robichaud.  If you are not on Rocaltrol you need to contact the office or go to the nearest Emergency department to have you calcium level checked.  All patients who undergo a total thyroidectomy will have their calcium monitored after surgery to determine if they need to take Rocaltrol and extra calcium when they go home. 15-20% of patients who undergo total thyroidectomy will have temporary loss of function of there parathyroid glands leading to abnormally low calcium levels which must be treated.

All patients should expect to have some neck pain and possibly headache after surgery.  This is from the positioning required to perform the procedure.  The neck is extended to optimize access to the thyroid or parathyroid glands, and identify important nerves and blood vessels during the surgery.  This can result in some post operative neck tension and secondary headaches which will resolve over time.  You will have appropriate pain medication prescribed to treat your pain as needed.  All patients undergoing partial or total thyroidectomy will need to have there thyroid hormone levels, TSH, checked 2-4 weeks after surgery and this will be arranged at your follow up appointment.

Follow up is recommended at 2 weeks following surgery. It is important that you don’t wait too long to book your follow up as that can make it very difficult to accommodate a timely appointment.