Thyroid Surgery: Common Questions and Concerns

by Columbia Surgery on September 16, 2013

Laurie Chabot, RN
Division of GI/Endocrine Surgery

Laurie Chabot, RN, has worked with patients in the Division of GI/Endocrine Surgery since 2008, and prior to that, in other divisions at NYP/Columbia. She is well versed in the concerns that patients have before thyroid surgery. In this post, she shares the most common questions she discusses with her patients every day.

Will I need to take calcium after surgery?

Calcium levels are controlled by the parathyroid glands, which are 4 delicate glands located near, sometimes adjacent to, or even within the thyroid gland. Approximately 5% of patients will have a temporarily low calcium level after the operation and less than 1% of patients may have a permanently low calcium level.  We routinely ask patients to take calcium supplements for the first few weeks after the operation to help avoid the symptoms of low calcium levels.

thyroid cancerWhat are the signs and symptoms of hypocalcemia (low blood levels of calcium)?

Symptoms of low calcium levels include numbness and tingling in the hands, the soles of your feet, and around your lips. Some patients feel a ‘crawling’ sensation in the skin, muscle cramps, or severe headaches. In rare cases, patients may have cramping and rigidity of muscles especially in the hands and legs.  Symptoms usually appear between 24 and 48 hours after surgery if they are going to appear.  Please keep in mind that other conditions like neuropathy and anxiety may cause some of the same symptoms and these symptoms might not be related to calcium levels.

If I have it, will hypocalcemia be temporary or last forever?

Approximately 5% of patients will have a temporarily low calcium level after the operation and less than 1% of patients may have a permanently low calcium level.  Only one parathyroid gland is needed for the whole body, and the chances of all four failing to recover is extremely low. In most cases, the need for supplemental calcium will end after about two weeks.

How much calcium do I need to take calcium after thyroid surgery?

We ask patients to take 1000 mg of calcium 4 times a day for the first week after surgery and then 500 mg of calcium twice a day for the next 2 weeks until their post-operative visit to help avoid the symptoms of low calcium levels.  If you have symptoms of low calcium levels after the operation, take an extra 1000 mg and wait 30 minutes.  If the symptoms do not go away after 30 minutes, take an extra 1000 mg and wait another 30 minutes.  If the symptoms still have not improved, please give your surgeon a call.  At that point, they may ask you to have a blood test and will likely prescribe supplemental vitamin D (called Calcitriol or Rocaltrol) to help your intestines absorb more calcium.

How large will my scar be?

Our surgeons take several steps to minimize surgical incisions and post-operative scarring. They use minimally invasive techniques for all procedures and most incisions are 1 to 1.5 inches long.  More importantly, they carefully place the incision in a natural skin line which will act like camouflage.  As the redness fades, the incision blends right into the skin line.  Finally, our surgeons put in a stitch to close the skin that they remove a few hours after the operation.  By not having the foreign material of a suture in the neck, the body has less to react to and so the incision fades faster. Over time, the majority of incisions fade to become virtually unnoticeable.

What is the best way to minimize my scar?

After the surgical glue falls off, there are several steps you can take. First and foremost, protect it from the sun and use sunblock over the area so that the incision does not tan darker than the surrounding skin – this is very important. Second, you can apply vitamin E, a scar-reducing product such as Mederma, or other moisturizing cream that has worked for you in the past, as long as it doesn’t irritate the incision.  Most patients do not put anything on it, and the incisions heal beautifully. After the first 2 weeks, gently rubbing the area will help improve circulation and healing and will help break up scar tissue.

166258239How long will I need to be in the hospital?

Depending on the time you undergo surgery, your medical history and your condition after surgery, you may stay in the hospital overnight. However, 95% of our patients can go home the same day after a six-hour observation period.

Will I have local or general anesthesia during surgery?

Our surgeons prefer using general anesthesia because it reduces the likelihood of unintentional movement during surgery, and patients tend to be more comfortable. If patients prefer local (also called ‘twilight’) anesthesia or if they have contra-indications to general anesthesia, then local sedation may be an option.  Ultimately, the type of anesthesia used is a decision that you will make with both the surgeon and anesthesiologists.  The anesthesiologists may not allow a local anesthetic technique to be used if you have other medical conditions like reflux disease or sleep apnea.

Will my voice be affected by thyroid surgery?

Temporary voice changes such as hoarseness or weakness occur in about 3% of patients. Less than 1% of patients will have a permanent change.

When can I resume normal activities?

Most people can return to work and normal activities, including exercise, sexual activity, and flying on an airplane, about a week after surgery.

How can I know if my surgeon is an expert in thyroid/parathyroid surgery?

Research shows that experienced surgeons who specialize in thyroid operations have superior surgical outcomes and less frequent complications than providers who only rarely perform thyroid surgery. According to national standards, high volume surgeons perform 50 or more thyroid surgeries per year and have done more than a thousand in their careers.

Learn more about thyroid cancer and its treatment at the New York Thyroid Center or call 212-305-0442

{ 7 comments… read them below or add one }

jake t. November 16, 2013 at 3:03 am

I am a multinodular non-toxic goiter patient, and I have a limited idea about my condition. Thanks to your website and now I have a better knowledge about Goiter Surgery.

Edward K. January 13, 2014 at 11:49 am

I’m having my thyroid removed soon for a suspicious nodule and this article was very helpful. Ill give it to my surgeon’s nurse.

Columbia Surgery January 13, 2014 at 11:59 am

We’re glad to hear this article is helpful! If you would like to learn more about thyroid cancer and its treatment, please visit our website at the New York Thyroid Center or call 212-305-0442

BELKIS C. March 7, 2014 at 1:35 pm

I AM HAVING MY THYROID REMOVED AND THANK YOU FOR THIS ARTICLE NOW I HAVE MORE OF UNDERSTANDING OF MY CONDITIONS.

Columbia Surgery March 7, 2014 at 1:41 pm

Belkis,

We’re glad to hear this article was helpful for you! If you would like to learn more about thyroid cancer and its treatment, be sure to visit our website at: New York Thyroid Center . If you would like to arrange an appointment with one of our doctors, I would also like to encourage you to call our new patient coordinators at 212-305-0442. Wishing you good health.

stephanie March 8, 2014 at 7:21 pm

I had a total Thyroid removal December of 2013 and my levels have gone from a 3.6 to 256 since. why? This surgery was supposed to make me feel better and with levels this high I guess you can gues that is not the case! Can someone please explain this to me? I have a Dr. appt soon but Im tired of waiting for months for answers!!!!!!!

Columbia Surgery March 11, 2014 at 10:46 am

Hi Stephanie,

I am sorry to hear about your frustrations. Unfortunately without a medical examination from our team, we cannot offer the advice you seek. I encourage you to contact our patient coordinator at 212-305-0442 if you would like to arrange a consultation. You may also visit http://columbiathyroidcenter.org for more information about the New York Thyroid Center and treatment options. Thank you and please let us know if we can help you further.

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