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THYROID/PARATHYROID GLAND SURGERY: PATIENT INFORMATION
Date:_____________________
Dear _____________________:
Please find the following literature informative and helpful with respect to your upcoming surgical procedure.
The procedure you are scheduled for is called a thyroidectomy (partial or total) or parathyroidectomy. Both glands
are categorized as endocrine glands which regulate specific critical body functions. The thyroid gland produces thyroid
hormones (T3 and T4) which is released into the blood stream and controls the body’s metabolism. Thyroid hormone is
counter-regulated by a hormone produced in the pituitary gland called thyroid stimulating hormone (TSH). A thyroid
gland may be overactive (hyperthyroid), thus producing too much thyroid hormone (commonly seen in an autoimmune
condition called Grave’s disease), underactive (hypothyroid) releasing suboptimal thyroid hormone, or contain solitary
or multiple nodules (goiter). The thyroid gland may be removed for a variety of conditions: an overactive thyroid
(Grave’s disease), thyroid cysts, symptomatic multinodular goiters, or a thyroid gland containing nodules suspicious for
malignancy (cancer). There are four types of thyroid cancer; namely, papillary, follicular, medullary and anaplastic
which require surgical intervention: typically a total thyroidectomy. If a thyroid cancer is found during surgery,
additional surgery may be required to address the lymph nodes (neck dissection) which drain the thyroid gland.
Even though most thyroid nodules are benign (approximately 90%), specific tests may be recommended preoperatively
to work up thyroid carcinoma. A solitary thyroid nodule, a nodule progressively enlarging in size, a “cold” nodule on
thyroid uptake scan, and a biopsy supportive of a follicular lesion or carcinoma often increases suspicion for a thyroid
malignancy. Typically, a diagnosis of thyroid cancer cannot be made until the gland containing the suspicious lesion is
removed and reviewed by a specialized physician named a pathologist during surgery. Rarely, the diagnosis cannot be
made during surgery and requires a special staining process in the postoperative period.
The parathyroid glands regulate the calcium level in the blood by a hormone named parathyroid hormone (PTH). This
hormone increases the serum calcium levels by increasing intestinal absorption and reducing urinary excretion of
calcium, and increasing calcium release from bones. Indications for surgery on parathyroid glands include overactive
parathyroids (hyperparathyroidism) by which there is elevated PTH and calcium in the blood promoting bone
resorption, osteoporosis and kidney stones. The parathyroids are critical in controlling the calcium level which is
essential for muscles, nerves and the heart to function normally. Symptomatically, patients with elevated calcium levels
experience abdominal pain, bone pain, generalized aches and pains, kidney stones and psychological mood swings.
Typically, hyperparathyroidism is due to an abnormally enlarged parathyroid gland (parathyroid adenoma) or
enlargement of numerous thyroid glands (parathyroid hyperplasia) which requires surgical exploration and removal of
the involved glands. Rarely, a parathyroid gland would be removed for a malignancy (cancer).
The surgical procedure for removal of thyroid or parathyroid glands is performed under general anesthesia through a
lower neck incision (9-10 cm) performed in a natural skin crease. Either a portion (lobectomy/isthmectomy) or all the
thyroid gland (total thyroidectomy) will be removed depending upon the disease process present within the gland. If the
operation is for parathyroid disease, the thyroid will be exposed and retracted to explore the parathyroid glands which
lie in proximity to the posterior aspect of the thyroid gland. These glands are very small and tedious to find surgically.
Both procedures require identification of the recurrent laryngeal nerve on each side of the neck which innervates the
voice box responsible for normal vocal projection and speaking. Typically these nerves are dissected and preserved, but
at times are sacrificed if involved by tumor. A drain will be inserted into or near the incision and typically removed
during dressing change the day after surgery. Patients are often discharged the day after surgery, however, if a total
thyroidectomy or a parathyroidectomy is performed, hospitalization may be required for a few days in order to monitor
the calcium level in the blood.
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Last Update May 4, 2017
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As with any surgical procedure, complications can occur and include:
1. Bleeding: This may occur during or after surgery. Though rare, another procedure would be necessary to control
and identify any persistent bleeding. A blood transfusion very rarely may be required.
2. Infection: Though rare, signs of infection would include redness, swelling, tenderness, elevated temperatures and
drainage occurring at approximately 3-4 days after surgery. This would require antibiotics and may require a
drainage procedure.
3. Nerve Injury: Temporary or permanent: The recurrent laryngeal nerves which supply the voice box may result in
temporary or permanent hoarseness, voice fatigue, difficulty achieving high vocal tones, or speech difficulties.
These nerves are monitored during surgery with an endotracheal tube muscle monitor, however, during the course
of the procedure these nerves are dissected away from the thyroid gland and become temporarily strained or bruised
which may render them dysfunctional for several weeks to months. If temporary, vocal function may take an
extended period of time to return back to normal function. Occasionally a thyroid cancer will invade the nerve,
rendering it permanently paralyzed, or the nerve has to be sacrificed in order to completely excise the tumor
intraoperatively. Recurrent laryngeal nerve dysfunction may also lead to airway problems promoting airway
obstruction. If both vocal cords become permanently or temporary damaged, the voice box cannot open and rarely
a tracheotomy may be required. Thereafter, additional surgery for voice rehabilitation may be indicated.
4. Excessive scarring or keloid formation at the surgical site. Scar gel or serial steroid injections are treatments.
5. Esophageal or tracheal damage: These structures lie in proximity to the thyroid and may require repair if
entered.
6. Fluid collection: Accumulation of fluid or blood requiring additional drainage procedure.
7. Major nerve or blood vessel injury: If additional surgery is required; namely, a neck dissection, temporary or
permanent nerve dysfunction may occur leading to lower lip asymmetry and weakness, tongue weakness, altered
tongue sensation, swallowing and speech difficulties, hoarseness, eye changes and shoulder weakness. If one of
these nerves is injured, there could be prolonged or permanent weakness of the muscles of the neck and facial
region. It is not uncommon to have some numbness following the surgery.
8. Airway obstruction.
9. Tumor recurrence.
10. Others.
11. No guarantees can be expressed or implied as to the outcome of the surgery.
12. Additional surgical or nonsurgical therapy may be required dependent upon individual healing response and the
final postoperative pathology diagnosis; especially if the tumor is found to be malignant (cancerous).
13. Dependent upon the amount of surgery required on the thyroid gland postoperative thyroid replacement therapy in a
pill form (Synthroid, Levoxyl) may be required daily on a temporary or indefinite basis (partial or total
thyroidectomy). Surgery on the thyroid gland or parathyroid glands may result in transient or permanent low blood
calcium levels (hypocalcemia) requiring daily temporary or indefinite calcium and/or vitamin D replacement to
maintain appropriate calcium blood levels. Thyroid or calcium levels are monitored by blood testing levels. One
should expect to submit blood samples postoperatively to assess thyroid function and provide a serum TSH level on
an annual basis.
Postoperative Care:
1. You may resume your normal diet postoperatively.
2. Take all medications as prescribed. You will be provided with pain medication to ease your discomfort
postoperatively.
3. Avoid smoking, alcohol, aspirin or aspirin containing products, anti-inflammatory medications (i.e., Advil, Motrin,
ibuprofen, etc), vitamin E or herbal supplements for up to two weeks postoperatively to avoid blood thinning,
secondary bleeding and poor wound healing.
4. Drains will be pulled and incisions treated prior to your discharge from the hospital. You will be discharged with a
neck dressing which should be removed at home the second day postoperatively. The incisions should be kept
clean daily with peroxide and lightly coated with antibiotic ointment (Bacitracin or Polysporin) 2-3 times daily.
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Last Update May 4, 2017
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The incisions should be left open to air exposure. You may shower the day after the drain has been removed, but
attempt to keep the incision as dry as possible.
5. Sleep on your back with the head elevated for the first week after surgery.
6. Avoid any tension or trauma to the surgical incisional site (shave towards the incisions) and avoid rigorous
scrubbing at the incision during washing. You should avoid hyperextending your neck or turning your head to left
and right extremes for up to two weeks after surgery.
7. Activity: Avoid all strenuous activity for up to two weeks after surgery (i.e., bending, heavy lifting, sexual activity
or sports). Furthermore, one should avoid driving for up to ten days postoperatively.
8. Your sutures will be removed seven days after surgery during your follow-up office visit. Please call to arrange
this visit. The pathology report will be reviewed with you as soon as the report is available, or at your
postoperative visit.
9. Please contact the office immediately if you develop any signs of infection or any postoperative concerns. Office
(303) 651-6770 or Answering Service (303) 684-3043.
10. Expectations: A mild sore throat after surgery is common due to intubation during general anesthesia. Your
surgical site will become sore and swollen. The surgical site, incision and overlying skin are often numb for weeks
after surgery. Swelling and bruising are expected and become more visible days 2-4 after surgery, with mild
swelling lasting several weeks postoperatively. Incisions and surgical sites typically remain firm/lumpy (indurated)
for usually three months prior to softening. Incisions should be protected from direct sun exposure and treated with
broad spectrum (UVA/UVB) sunscreens (please inquire with our office staff about appropriate sunscreen
recommendations) for up to 3-6 months after surgery to avoid dark pigmentation of the scars. Our office will also
provide suggestions for management of scars postoperatively to achieve optimal results.
11. Patients diagnosed with malignant (cancerous) thyroid tumors must be seen in follow-up at consistent scheduled
intervals as recommended for up to five years after surgery to screen for any early recurrence of disease.
Please note that the majority of thyroid/parathyroid operations are uneventful and very well tolerated. The hospital
staff, my office personnel and I look forward to working with you personally and shall support you during your hospital
stay and through your recuperation. I encourage you to contact me at any time for assistance or assurance.
Please acknowledge your review and understanding of all the aforementioned information by signing below.
______________________________
Patient Signature
____________________________
Date
______________________________
Witness/Surgeon Signature
____________________________
Date
PMS/rdc-12/9/09
(Thyroidectomy/parathyroidectomy)
Thyroid Patient Info
Last Update May 4, 2017
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