Pain
Thyroid surgery rarely causes significant pain. But, almost all patients complain of discomfort with swallowing for 2–3 days after surgery. We recommend using ibuprofen (e.g., Motrin or Advil), 400 mg every 6 hours around the clock for the first 2–3 days. If your pain/discomfort is not adequately controlled, you can either increase the ibuprofen to 600 mg or even 800 mg every 6 hours, or you can add the narcotic prescribed by your surgeon. We typically give patients a prescription for a small number of Percocet (Tylenol with oxycodone). You can combine 1 or 2 Percocet tablets with the ibuprofen every 6 hours. Ibuprofen is a safe medication, as long as you have normal kidney function and you do not use it for an extended period of time (e.g., more than 1 week). Percocet and similar medications containing opioids are safe when used as directed and for a short period of time.
Infection
Infection of a surgical wound in the neck is extremely rare. Even if you see some swelling and mild redness around the wound, this is probably not due to infection. A true wound infection appears as angry redness around the wound that is expanding. If you suspect a wound infection, you should contact your surgeon, but remember that wound infections in the neck after thyroid and parathyroid surgery are exceedingly rare.
Hypocalcemia
A low calcium level, or hypocalcemia, is the most common complication after thyroid surgery. This occurs because the parathyroid glands are not functioning properly. The parathyroid glands produce a hormone (PTH) that controls calcium levels in the blood stream. Hypocalcemia after thyroidectomy may be due to the fact that several of these tiny glands have been removed inadvertently and/or that the blood supply to the parathyroid glands has been compromised. The thyroid gland and the parathyroid glands share blood vessels, and it is quite common that the blood supply to one or more of the parathyroid glands is tied off during thyroid surgery. In most cases, this results in a temporary drop in the calcium level. However, in very rare cases, patients can develop permanent hypocalcemia.
Typically, hypocalcemia is only a problem after total thyroidectomy. Patients who undergo thyroid lobectomy, or hemithyroidectomy, will almost never see a drop in their calcium level because only 2 of the 4 parathyroid glands are being disturbed. If you are undergoing total thyroidectomy, your surgeon will most likely give you instructions to take calcium tablets for 2 weeks after the operation in order to prevent any symptoms of hypocalcemia while the parathyroid glands recover. We usually recommend Tums Ultra 1000 (double strength Tums), 1 tablet 3 times a day for 2 weeks. If you develop symptoms of hypocalcemia despite taking the Tums, you will need to increase the number of tablets that you take each day. The exact number of tablets necessary to control the symptoms will be different for every patient. Some patients will need to take 4 or 5 tablets each day, while other may need 10 or 12 tablets per day. In addition to the use of Tums, we will often prescribe calcitriol (Rocaltrol) in patients who are symptomatic. Calcitriol is a very strong form of vitamin D and will help increase the calcium level in the blood stream within about 24 hours.
Hoarseness
Mild temporary hoarseness is not uncommon after thyroid surgery. This can happen for a variety of reasons, including irritation of the vocal cords caused by insertion of the breathing tube and inflammation around the nerves that control the vocal cords. In most cases, this mild hoarseness resolves within a couple of days. More severe hoarseness and permanent hoarseness are very rare complications of thyroid surgery (<1% of cases). If you feel that your voice is not returning to normal, you should discuss this with your surgeon. Patients with these rare complications will often be sent to a vocal cord specialist for a detailed evaluation of the problem.
Bleeding
Bleeding during and after thyroid surgery is an uncommon situation. We will typically only lose a few drops of blood in the operating room. And, the wound in your neck will only be closed when there is no evidence of any further blood loss. Nevertheless, in very rare instances, patients may developed bleeding inside the neck after the wound has been closed. This results in obvious swelling of the neck, and occasionally patients will have difficulty breathing. Keep in mind that the majority of patients who develop swelling of their neck only have a simple fluid collection inside the wound. This is not life threatening and will resolve on its own. You should only be concerned if the neck swelling is firm and growing larger. In this case, you should contact your surgeon and consider going to the emergency room.
Steven E. Rodgers, MD, PhD
Dr. Rodgers is an experienced thyroid surgeon at the University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center near downtown Miami. He is a general surgeon who completed a 2-year fellowship in surgical oncology at the University of Texas M.D. Anderson Cancer Center. Dr. Rodgers has been in practice since 2006, when he completed his training. He routinely performs total thyroidectomy, thyroid lobectomy, central compartment lymph node dissection, lateral cervical lymph node dissection (aka modified radical neck dissection, functional neck dissection, or selective neck dissection), and removal of substernal goiters. More information about Dr. Rodgers can be found at About Dr. Rodgers and at UMiamiHealth.org.