Thyroid Surgery: Types, How to Prepare & Recovery

Updated in August 2023

Thyroid surgery is performed to treat thyroid conditions, like nodules, cysts, and significant increases in size. Thyroid removal can be total or partial, depending on the condition being treated. 

Thyroid surgery is done under general anesthesia and consists of a small incision on the neck. Although it is a delicate organ, complications are not common, even when treating cancer. Many patients do not experience voice changes or hematomas after thyroid surgery. 

Thyroid surgery recovery is also uncomplicated. The doctor will advise the patient to avoid any heavy lifting to prevent swelling and bleeding to the incision. A scar may persist on the neck, and the patient will likely need to continue life-long thyroid hormone medication to maintain stable thyroid hormone levels. 

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Types of thyroid surgery

The main types of thyroid surgery include:

  • Total thyroidectomy, which consists of complete removal of the thyroid. This will require hormonal replacement therapy following surgery. 
  • Lobectomy or hemithyroidectomy, which consists of removing just one side and the isthmus (which is the part that unites the two sides of the thyroid), and maintaining the functioning side. This may be recommended for cases of thyroid cancer (like papillary or follicular thyroid cancer), and will need ongoing assessment to determine the need for hormonal replacement therapy. 
  • Cervical neck dissection: In addition to removal of the thyroid, the lymph nodes surrounding the thyroid in the cervical neck will also be removed. This is mainly done in cases of thyroid cancer (medullary or anaplastic thyroid cancer). In cases of follicular or papillary cancer, the dissection may not need to be performed if these lymph nodes are not affected. 

Following surgery, the doctor should assess the need for radioactive iodine treatment, which helps to completely eliminate any cancerous cells left behind. 

How to prepare

Generally, before thyroid surgery, you should fast for 8 hours and discontinue any anticoagulant medications about 10 days before the procedure, as advised by your doctor. This is to prevent the risk of significant bleeding during surgery and healing. 

How it is performed

Thyroid surgery is performed under general anesthesia and lasts for about 2 hours. The surgery consists of a small incision to the neck to observe the thyroid gland and then to remove it completely or just one side, which may or may not be followed by removal of surrounding lymph nodes. The technique performed depends on the severity of the disease. 

In most cases, patients remain admitted in the hospital for a day or two, and then are discharged home, It is important to follow post-surgical care as advised by your doctor, and to avoid strenuous activity in the following weeks. 

Recovery after thyroid removal

It takes about 15 days to recovery from thyroid surgery. During this time, you should avoid physical activity, like running and intense house chores, to prevent swelling and bleeding to the incision. Total rest is not necessary, however, and in most cases, you can walk, work and move your neck a week after surgery. 

After leaving the OR, the doctor may attach a small drain to remove excess fluid and prevent bruising. It is normal to experience some pain, and the doctor may prescribe analgesics and anti-inflammatories after surgery. Patients are usually also advised to consume a liquid or soft diet to reduce discomfort on the throat. 

In addition, you should maintain a dressing on your neck to protect the incision from bacteria, dirt and sun exposure. This dressing should be kept dry. Normally, the patient will go home with the dressing, which should be removed 3 days after the surgery. The stitches are also removed as directed by the doctor. 

What happens after thyroid removal?

Generally, thyroid surgery does not lead to complications. However, the most common complications include: 

  • Throat pain and coughing, which can make eating more difficult. This resolves within a week and is related to throat inflammation. 
  • Voice changes, like hoarseness and fatigue when speaking. This can resolve on its own within months, although some cases will require vocal training.
  • Reduced calcium levels in the blood, as the parathyroid glands that are beside the thyroid, and produce PTH which are responsible for regulating calcium levels.
  • Neck bruising, which can lead to pain and swelling

Because an incision is done to the neck, a thin scar may remain, varying between 3 and 15 cm. 

Does removing your thyroid lead to weight gain?

If hormone replacement therapy is not completed after thyroid removal, the patient may develop hypothyroidism. This condition is associated with symptoms like weight gain and body swelling. Therefore, it is important to adhere to hormonal replacement therapy as prescribed by your doctor to maintain your weight and to ensure other body functions remain normal, like body temperature control. 

Removing just half of the thyroid can lead to weight gain if the remaining half is not able to produce the hormones the bod needs. Therefore, patients will likely undergo periodic blood tests and assessment to investigate for any symptoms related to hypothyroidism. 

If iodine therapy is indicated after surgery, hormonal medications will likely not be prescribed. Therefore, during the treatment interval, it is common for patients to notice swelling, headaches and lack of concentration. After iodine therapy, the doctor may prescribe thyroid medications to relieve symptoms. 

How to live without a thyroid

It is possible to live without a thyroid because the hormones produced by this organ can be substituted with medications containing the minerals and hormones needed for normal body functioning. These are usually taken when fasting in the morning. 

After total removal of the thyroid, medications are taken for lifelong to ensure hormone levels in the body remain stable. This can help to prevent symptoms like cramps and numbness.

When just half of the thyroid is removed, hormone replacement therapy may not always be needed. The remaining half is able to compensate and produce the hormones the body needs. However, the doctor should order blood tests and ultrasound to ensure the surgery was successful and that the remaining half is functioning as intended.