What are the complications of thyroidectomy?

If you are having thyroid surgery, known as a thyroidectomy, to remove all or part of your thyroid gland—a butterfly shaped organ at the base of your neck—it's important to know what to expect as you recover.

Side effects, such as neck pain and stiffness or sore throat, are common after surgery. Complications are rare but can be serious and even potentially life-threatening if they do occur.

This article explores common side effects of thyroid surgery, what to expect during the recovery process, and warning signs of complications.

There are a number of short-term side effects that people may experience after thyroid surgery. Most of these will be temporary, but some may persist.

Neck Pain and Stiffness

The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.

Many surgeons recommend doing gentle stretching and range-of-motion exercises to reduce stiffness. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises they believes might be helpful, how often you should perform them, and whether there are any exercises you should avoid. Recommended exercises may include:

• Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
• Gently tilt your head to the right and then to the left.
• Rotate both shoulders forward in a circular motion.
• Slowly raise your arms overhead, and then slowly lower them back down against your body.

Suggested frequency: 10 repetitions, three times day

Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours does not, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation (a physiatrist) or a physical therapist who can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility.

A Sore Throat

Thyroid surgery is often done under general anesthesia with a breathing tube placed in the windpipe, or trachea, to breathe for you. This can lead to a sore throat and the sensation of a lump—like something is stuck in your throat—with swallowing.

Using an over-the-counter (OTC) numbing throat spray, such as Chloraseptic, or numbing lozenges, such as Cepacol, can help with the discomfort until you are healed.

Difficulty Swallowing

Dysphagia, or swallowing problems, are common after thyroid surgery, though they usually don't last long, often resolving within two weeks. Eating soft foods for the first few days can be helpful. Examples include foods with sauces or gravy, cooked vegetables, and casseroles.

Hoarseness and Voice Problems

After surgery, your voice may be hoarse or whispery, and it may feel tiring to talk. This is very common and expected during the first week or two after surgery. While around 1% of people may have damage to the nerves supplying the vocal cords, around 5% to 10% of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward.

Symptoms usually improve in the first few weeks but may persist up to six months after surgery. While there is no specific treatment for this hoarseness, it's helpful for your loved ones to be aware of the problem so that you don't feel the need to talk loudly or more often than is comfortable. If the nerve was injured, more severe symptoms may be noted after surgery.

Nausea or Vomiting

Nausea and vomiting after thyroidectomy was the norm at one time, and people may be concerned if they talk with others who had this procedure in the past.

Fortunately, if nausea does develop, there are treatments that can alleviate your symptoms, and the use of medications such as dexamethasone has greatly reduced vomiting.

Transient Hypoparathyroidism

Transient (temporary) hypoparathyroidism can happen after thyroid surgery. Hypoparathyroidism is when you have too little parathyroid hormone, which can lead to low calcium levels.

The four parathyroid glands lie on the back of the thyroid gland and are sometimes injured or removed during surgery. These glands are responsible for controlling the body's calcium levels. They secrete parathyroid hormone that helps your kidneys and bones to maintain the balance of calcium and phosphorous.

Roughly 5% of people may have temporary symptoms of a low calcium level, known as hypocalcemia, for at least a few weeks after thyroid surgery. It may last for up to six months.

Since it's common for the parathyroid glands to function poorly after a thyroidectomy, you may be sent home with calcium and vitamin D supplements. When you have your follow-up appointment, your surgeon will check your blood calcium level.

If you are not given calcium, it's important to be aware of the symptoms of hypocalcemia. They commonly include:

• Numbness around the mouth
• Tingling in the fingers
• Muscle spasms or cramps

Most often calcium levels improve in a few weeks but may continue to be low for up to six months. During this time, your healthcare provider will monitor your calcium levels to determine when you can stop using your supplements (or much less commonly, if you will need to continue these indefinitely).

A 2018 study found that when a solution of potassium iodide was given prior to thyroid surgery for those with Grave's disease—a condition that can lead to an overactive thyroid—it was associated with less temporary hypoparathyroidism and hoarseness. It may also improve the safety of the procedure for those with Graves disease. You can ask your surgeon about this prior to your surgery.

Hypothyroidism

If you have a total thyroidectomy, or the entire thyroid gland is removed, you will require prescription thyroid replacement therapy after their procedure. This is because you'll no longer have a gland to make thyroid hormone and will experience symptoms of hypothyroidism, or an underactive thyroid, without replacement therapy.

If you have a subtotal thyroidectomy, which means all but a small portion of your thyroid is removed to try to preserve thyroid function, hypothyroidism sometimes still occurs and you will need monitoring to see if replacement therapy is needed.

If your healthcare provider prescribes thyroid replacement therapy, be sure to have a conversation with them before leaving the hospital about when to start the medication, which medication you need, and at what dosage. It's also important to talk about how to properly take your medication, as food and many drugs and supplements can interfere with absorption.

If you had a subtotal thyroidectomy and are not immediately put on thyroid hormone medications, watch carefully for symptoms of hypothyroidism and contact your healthcare provider if they occur. Having regular thyroid testing done is also important, as hypothyroidism may not occur right away, or even for months or years.

There are many symptoms of hypothyroidism, but some of the more common ones include:

• Feeling cold, especially in the extremities
• Dry, coarse skin
• Unexplained or excessive weight gain
• Fatigue and sluggishness
• Constipation
• Muscle cramps
• Increased menstrual flow and more frequent periods
• Depression and difficulty concentrating
  

Thyroidectomy Recovery Stories From 3 Different Patients

Recap

Side effects of thyroid surgery are common and often include neck pain, a sore throat, difficulty swallowing, and hoarseness. You may be given calcium and vitamin D supplements, and hormone replacement therapy is needed in some cases.

Complications

Though thyroid surgery is considered a relatively safe procedure, complications may sometimes occur. Some of these require prompt treatment, so it's important to be aware of them.

Hematoma

Bleeding into the tissues surrounding the neck, which is known as a neck hematoma, is uncommon, but is potentially life-threatening if not diagnosed and treated promptly. Occurring in roughly one in 300 procedures, most hematomas occur within 24 hours of surgery, though research indicates they may occur later in 10% to 28% of cases.

Symptoms may include an area of firmness and swelling on the front or side of the neck (usually beneath the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, lightheadedness, or stridor (a high-pitched wheezing sound that's usually most noticeable with inspiration than exhalation).

Treatment includes immediate surgery to remove the hematoma and address any areas of bleeding.

Permanent Hypoparathyroidism

While temporary in some cases, hypoparathyroidism caused by the injury or removal of parathyroid glands can be permanent. As only one of the four parathyroid glands is needed to regulate calcium levels, the condition is uncommon, affecting roughly 2% of people who have a thyroidectomy.

Factors that increase the risk of hypoparathyroidism after thyroid surgery include a diagnosis of thyroid cancer, a longer duration of thyroid disease before surgery, a central incision, and the removal of a large amount of thyroid tissue.

If calcium supplementation is not used and the condition is permanent, further symptoms may include tingling and numbness of the bottoms of the feet, muscle cramps and twitches, anxiety, depression, and headaches.

If hypocalcemia is severe, the condition can progress to symptoms of abnormal heart rhythms (arrhythmias), difficulty breathing (due to muscle spasms in the voice box), kidney stones, heart failure, and/or seizures. As with other side effects and complications, the timing of symptoms can vary from one person to the next.

Most often, lifelong calcium supplementation is all that is needed. But if severe symptoms occur, intravenous calcium, which is delivered through a vein, in the hospital may be required.

Laryngeal Nerve Injury

Less than 1% of people having a thyroidectomy will experience damage to either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. If hoarseness persists, especially if it is still present six months after surgery, it's likely that the recurrent laryngeal nerve was injured. This nerve controls the muscles that move the vocal cords.

In addition to persistent hoarseness, injury to the recurrent laryngeal nerve may lead to other symptoms after surgery. These can include uncontrolled coughing when speaking, difficulty breathing, or the development of aspiration pneumonia—which is pneumonia caused by substances, such as from the mouth, getting into the lungs.

If any of these symptoms occur, immediate evaluation by a healthcare provider or an ear, nose, and throat (ENT) doctor is recommended. The ENT doctor will perform a procedure called a direct laryngoscopy to visualize the vocal cords and see if a tracheostomy, an incision in the neck for breathing, is needed. This is uncommon and primarily a concern if both nerves are damaged.

Injury to the external branch of the superior laryngeal nerve is usually less obvious. When injured, a person may have difficulty making high-pitched noises or yelling, though their routine speaking voice may be unchanged.

Infection

The risk of infection is present with any type of surgery but is relatively rare with thyroid surgery. It occurs in roughly one in 2,000 surgeries. Treatment usually includes IV antibiotics, which are medications to kill bacteria that are delivered through a vein.

Seroma

A seroma is a collection of fluid that can occur after many types of surgery. While the fluid is often reabsorbed by the body, large seromas may need to be drained.

Thyroid Storm

Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease.

Symptoms of thyroid storm include a fever (over 102 degrees F in most people), profuse sweating, a rapid heart rate, and sometimes delirium (severe confusion).

The use of iodine was thought to reduce the risk, but a 2017 study questioned the benefit. Treatment in the intensive care unit includes cooling, intravenous fluids, medications such as propylthiouracil (PTU), and management of arrhythmias.

Anesthesia Risks

Possible complications of general anesthesia may also occur since most thyroidectomies require it. This can include changes in blood pressure or heart problems.

Recap

Complications after thyroid surgery are rare but can be serious and potentially life threatening. Seek urgent medical care if you experience any swelling of your neck, increased pain, shortness of breath, fever, or difficulty breathing.

Risk Factors

While complications can affect anyone, there are some risk factors that increase the chance of the adverse effects. These include:

• Being older than age 65
• Smoking
• The presence of other medical conditions, such as congestive heart failure or a bleeding disorder
• Thyroid cancer, especially when a central neck dissection is done to remove lymph nodes
• Repeat thyroid surgery

While a total thyroidectomy is more extensive surgery than a subtotal thyroidectomy, several studies suggest that the safety of the two procedures is similar with regard to complications, though temporary low calcium levels (and hypothyroidism due to the removal of the entire thyroid) are more common with the total procedure.

Inpatient vs. Outpatient

There has been some controversy over inpatient vs. outpatient thyroidectomies, especially with the recent trend toward same-day surgery. The primary reason for concern is that neck bleeding, which can be life-threatening, may occur after a person has returned home after outpatient surgery.

As far as safety, a 2018 study suggests that outpatient surgery may be safe, but the researchers admitted that the study may be biased (people who were are at greater risk are more likely to be hospitalized, whereas those at lower risk were more likely to be offered the procedure on an outpatient basis).

Healthcare Provider Volume and Expertise

Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. With this in mind, it's a good idea to ask your surgeon how many thyroidectomies they have performed in the past.

You may also wish to ask about their complication rate, but this is not necessarily an accurate measure of competence. For example, more experienced surgeons may agree to take on more challenging cases that are likely to have a higher complication rate, and less experienced surgeons may limit themselves to low-risk cases.

Recovery

After surgery, you will be monitored in the recovery room, sometimes for up to six hours. During this time, the staff will monitor you closely for any signs of neck swelling that could indicate a neck hematoma.

You may remain in the hospital overnight or be allowed to return home if you had outpatient surgery and are stable. The head of your bed will be raised to reduce swelling, and you will be allowed to eat a regular diet. If your throat is sore or if swallowing is painful, eating a diet of soft foods will be more comfortable.

Before you leave the hospital, your healthcare provider will go over any instructions and talk about when you should follow up with your surgeon. Be sure that you know what your at-home treatment regimen entails (medication, supplementation) and how to take any pain medications prescribed, if applicable. Keep in mind that pain medications can cause constipation, and your healthcare provider may recommend a stool softener and/or laxative.

Recuperation Time and Restrictions

Most people are advised to take roughly two weeks off from work to recuperate, depending on their occupation. You should not drive as long as you continue to need pain medications, and some surgeons recommend abstaining from driving for the first week after surgery altogether.

You should also avoid any heavy lifting or strenuous activities, such as many sports, for a few weeks. The excess activity could increase your chance of developing a hematoma or keep your wound from healing properly. Light housekeeping and walking are usually fine once you arrive home.

Caring for Your Incision 

Your surgeon will talk to you about whether you should continue to wear a dressing over your incision. Depending on the surgeon, you may have stitches that will need to be removed or absorbable sutures that will not. If Steri-Strips were applied, these will usually stay in place for around a week. Most surgeons recommend leaving these alone until they fall off by themselves, rather than trying to remove them.

You will probably be able to shower, but should try to keep your neck as dry as possible. You should not submerge, soak, or scrub your incision, and bathing in a tub should be avoided until you see your surgeon. After showering, you can lightly pat your neck dry or use a hair dryer set on the "cool" setting.

Your incision may appear red and hard at first, and you may notice some slight swelling and bruising around the scar. If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months.

In time, your incision will turn pink and then white, and most are completely healed in six to nine months.

Since the area around your incision will be prone to sunburns, wear sunscreen whenever you go outside for at least a year after surgery. If you are wondering what your scar may look like, the University of California Los Angeles has a scar gallery with photos of people who have had thyroid surgery at various points in the healing process.

Follow-Up

Generally speaking, you will usually need to return to the surgeon for a follow-up visit around one to two weeks after surgery. In the meantime, be sure to contact your thyroid-care team if you have any questions regarding your recovery process.

At your follow-up appointment, your surgeon will determine if you need to remain on calcium and vitamin D. If you were started on hormone replacement therapy, a thyroid-stimulating hormone test (TSH) should be checked about six weeks after surgery.

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Summary

Side effects of thyroid surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism that usually resoles within a few weeks.

Complications are much less common and can include neck bleeding, permanent hypoparathyroidism that requires ongoing calcium replacement, and damage to nerves that can lead to long-term hoarseness and vocal changes.

A Word From Verywell

Knowing what to expect before your thyroid surgery is helpful for coping with potential side effects, reducing complications, and undergoing an easier recovery process. As with any surgery, it's normal to have questions, concerns, and maybe even feel a little bit of anxiety going into it. Discuss what's on your mind with your healthcare provider. Keep in mind that even when complications occur, which is not common, prompt treatment is often successful to restore your health.

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