Post-Surgery Instructions for:

Total Thyroidectomy
Orlando Health Surgical Group Michael Kahky, MD, F.A.C.S
14 West Gore Street Marc Demers, MD, F.A.C.S
Orlando, FL 32806 Jeffrey R. Smith, MD, F.A.C.S
321-843-5001

WHAT YOU SHOULD KNOW: ·

A total thyroidectomy is surgery to remove your thyroid gland. Your thyroid gland makes
hormones that regulate your metabolism, body temperature, heart rate, and the level of
calcium in your blood. Your thyroid gland is shaped like a butterfly and found in the front lower
part of your neck.

CARE AGREEMENT:
You have the right to help plan your care. Learn about your health condition and how it may be
treated. Discuss treatment options with your caregivers to decide what care you want to
receive. You always have the right to refuse treatment.
RISKS:
You may bleed more than expected and need a blood transfusion. Your voice may be hoarse
or weak after surgery, and this may become a long-term problem. Your neck may be bruised
and swollen, and it may be hard for you to breathe or swallow. Your parathyroid glands may
not work as well as they should after surgery. This can cause your calcium blood levels to
drop too low. This may be a short-term problem after surgery, or it may be a long-term
problem.

You may get a wound infection, which may become life-threatening. You may get a blood
clot in your arm or leg. The clot may travel to your heart or brain and cause life-threatening
problems, such as a heart attack or stroke.

If you do not have surgery, your thyroid gland may keep growing, making it hard for you to
breathe or swallow. If your thyroid has cancer, it could spread to other areas of your body.
If a benign multinodular goiter is not treated, it could become cancer. Hyperthyroidism may
make your heart beat too fast or it may not beat regularly, and this can lead to heart failure.
It may also lead to low blood calcium levels and increased risk of bone fractures. You may
have eye problems, such as double vision, eye tenderness, or bulging. If certain thyroid
problems are not treated, they may become life-threatening.
 GEITING READY:
The week before your surgery:
• Write down the correct date, time, and location of your surgery.
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-
counter medicine before your procedure or surgery.
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell
your caregiver if you are allergic to any medicine. Tell your caregiver if you use any
herbs, food supplements, or over-the-counter medicine.
• Tell your caregiver if you know or think you might be pregnant.
• Your caregiver may have you take antibiotic medicine before surgery. This may help
prevent infections.
• You may need to take antithyroid medicine to decrease the amount of hormone made
by your thyroid gland.
• You may need to donate blood before your surgery. Your blood is stored in case you
need it during or after your surgery.
• You may need a neck ultrasound, a thyroid scan, an MRI, a fine needle biopsy, or a
laryngoscopy. These tests help caregivers learn more about your thyroid problem. Ask
your caregiver for more information about these and other tests that you may need.
Write down the date, time, and location of each test.
The night before your surgery: Ask caregivers about directions for eating and drinking.
The day of your surgery:
Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of
all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will
check that your medicines will not interact poorly with the medicine you need for surgery.

You or a close family member will be asked to sign a legal document called a consent form.
It gives caregivers permission to do the procedure or surgery. It also explains the problems
that may happen, and your choices. Make sure all your questions are answered before you
sign this form.

Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually
chosen. Through the IV tube, you may be given liquids and medicine.

An anesthesiologist will talk to you before your surgery. You may need medicine to keep
you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in
your family has had a problem with anesthesia in the past.

WHILE YOU ARE HERE:

Informed consent is a legal document that explains the tests, treatments, or procedures that
you may need. Informed consent means you understand what will be done and can make
decisions about what you want. You give your permission when you sign the consent form. You
can have someone sign this form for you if you are not able to sign it. You have the right to
understand your medical care in words you know. Before you sign the consent form,
understand the risks and benefits of what will be done. Make sure all your questions are
answered.
Before your surgery:
Informed consent is a legal document that explains the tests, treatments, or procedures
that you may need. Informed consent means you understand what will be done and can
make decisions about what you want. You give your permission when you sign the consent
form. You can have someone sign this form for you if you are not able to sign it. You have
the right to understand your medical care in words you know. Before you sign the consent
form, understand the risks and benefits of what will be done. Make sure all your questions
are answered.

Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually
chosen. Through the IV tube, you may be given liquids and medicine.

Tests:
Neck ultrasound: An ultrasound uses sound waves to show pictures on a monitor. An
ultrasound may be done to show the inside of your neck.
Thyroid scan: This test shows caregivers how well your thyroid is working. Radioactive dye
is put into your IV or is given to you to drink. The working part of the thyroid gland absorbs
(soaks up) the dye. Two to 48 hours later, caregivers put a machine called a scintillator over
your neck. The machine takes pictures showing the areas of your thyroid that absorbed the
dye.
MRI: This scan uses powerful magnets and a computer to take pictures of your neck
muscles, joints, bones, and blood vessels. You may be given dye to help the pictures show
up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not
enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if
you have any metal in or on your body.
Fine needle aspiration: This test is also called a FNA or fine needle biopsy. It is used to
collect fluid or take tissue samples from a cyst, lump, or mass.
Laryngoscopy: You may have this test before and after your surgery. This test helps your
caregiver know how well your larynx is working.
Antithyroid medicine: This medicine decreases the amount of thyroid hormone made by
your thyroid gland.

Anesthesia: This is medicine to make you comfortable during the surgery. Caregivers work
with you to decide which anesthesia is best for you.
General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may
be given through your IV. You may instead breathe it in through a mask or a tube placed
 down your throat. The tube may cause you to have a sore throat when you wake up.
Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain
during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the
skin where you will have surgery. You will be fully awake during the surgery or procedure.
You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means
you will also be given medicine through an IV. This medicine keeps you comfortable,
relaxed, and drowsy during the surgery or procedure.
During your surgery: Your surgeon will make an incision in your lower neck. He will remove
your thyroid gland. If you have cancer, your surgeon may also remove the tissue and lymph
nodes around your thyroid gland. If you are awake during surgery, you may be asked to speak
to your caregivers. One or more drains may be placed into your incision to remove extra fluids
from the surgery area. Your incision will be closed with stitches and covered with a bandage.
After your surgery: You will be taken to a room to rest until you are fully awake. Caregivers will
monitor you closely for any problems. A caregiver may remove your bandage soon after surgery
to check for swelling, redness, and drainage. Tell your caregivers if you have difficulty breathing
or swallowing. Tell them if your bandage feels like it gets tighter. Do not get out of bed until
your caregiver says it is okay. When your caregiver sees that you are okay, you will be taken to
your hospital room. You will have blood tests to check your calcium and thyroid hormone blood
levels. You may be given calcium through an IV placed in your arm or as a pill.
Deep breathing: This helps open air passages and prevent a lung infection. Slowly take a
deep breath and hold the breath as long as you can. Then let out your breath. Take 10 deep
breaths in a row every hour while awake. You may be asked to use an incentive spirometer
to help you with this. Put the plastic piece into your mouth and slowly take a breath as deep
and as long as you can. Hold it as long as you can. Then, let out your breath.

You will be able to drink liquids and eat certain foods once your stomach function returns
after surgery. You may be given ice chips at first. Then you will get liquids such as water,
broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be
given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you
may slowly begin to eat solid foods.

Drains: These are thin rubber tubes put into your skin to drain fluid from around your
incision. The drains are taken out when the incision stops draining.

Medicines:
Antinausea medicine: This medicine may be given to calm your stomach and to help
prevent vomiting.
Pain medicine:
Caregivers may give you medicine to take away or decrease your pain.
Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does
not decrease. The medicine may not work as well at controlling your pain if you wait too
 long to take it.
Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you
want to get out of bed or if you need help.
Thyroid hormone: You are given this medicine to bring your thyroid hormone level back to
normal.
Radioactive iodine: If your thyroid gland was removed because of cancer, you may need
radioactive iodine treatments. This medicine may kill cancer cells that were not taken out
during surgery.
AFTER YOU LEAVE:

Medicines:
Thyroid hormone: You are given this medicine to bring your thyroid hormone level back to
normal.

Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait
until the pain is severe before you take this medicine.

Take your medicine as directed. Call your primary healthcare provider if you think your
medicine is not helping or if you have side effects. Tell him if you are allergic to any
medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts,
and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.
Follow up with your endocrinologist or surgeon as directed: You may need to return to
have your bandage changed, drains removed, or more tests. Write down your questions so
you remember to ask them during your visits.
Self-care:
Drains: You may go home with one or more drains in your neck. Ask your surgeon for more
information about drains.

Swallowing and voice changes: You may have a sore throat, hoarse voice, or difficulty
swallowing after surgery. It is normal to have these problems for up to 6 months after total
thyroidectomy surgery.

Supplements: Ask your endocrinologist if you need to take calcium or vitamin D and how
much to take.
Contact your endocrinologist or surgeon if:
• You have a fever.
• You have questions about your drain.
• You have pain in your surgery area that does not go away after you take pain
medicine.
 • You lose weight, feel very nervous and hungry, and sweat for no reason.
• You feel very tired and cold, gain weight for no reason, and your skin is very dry.
• You vomit several times in a row.
• Your skin is itchy, swollen, or has a rash.
• Your incision is swollen, red, or has pus coming from it.
• You have new voice weakness or hoarseness, or it is getting worse.
• You have questions or concerns about your condition or care.
Seek care immediately or call 911 if:

• You have sudden tingling or muscle cramps in your face, arm, or leg.
• You have muscle spasms in your legs and feet that do not go away.
• You have sudden abdominal pain.
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
• Your incision comes apart, or blood soaks through your bandage.
• You have sudden swelling in your neck or difficulty swallowing.
• You suddenly feel lightheaded and short of breath.
• You have chest pain when you take a deep breath or cough, or you cough up blood.

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