Post-op advice: Thyroid and parathyroid surgery

In the first couple of days after thyroid and parathyroid surgery, you can expect to feel discomfort, tiredness, and a sore throat. It takes time to recover from surgery so taking a period of rest from work and activities is important. A combination of rest, pain relief and doing things you enjoy will help you achieve a quicker recovery. Mr James Kirkby-Bott, a leading consultant general surgeon, offers some advice on how to manage your recovery after thyroid surgery.

What to expect

It’s normal to feel unwell after any type of thyroid surgery and resting is important for your body to recover. However, try and remain active. As each day passes, try to slowly increase your activity levels by doing gentle exercise around the house. Go for a walk each day, but don’t do strenuous sports until you feel ready. Remember, it’s OK to enjoy your recovery time, after all, you’ve just had a big operation and will need some rest.

How to manage the wound and dressings

The wound is covered in a plaster and under this are small strips of plaster, called steristrips. These take tension off the edges of the wound. Leave these on for a minimum of 7 days and a maximum of 10 days. The dressing is waterproof and you can shower from day one. Just pat the dressing dry after.

You will have a bruise and mild swelling, which happens to everyone, the bruise will disappear overtime and the swelling will go down.

As part of your recovery stretch your neck passively and gently with little exercises several times a day. After 10 days remove any dressings that are still on the wound. After 14 days apply a moisturizer twice a day to the front of your neck. Rub firmly to improve the appearance of the scar. It takes a good 12 months for scars to fully heal and become a thin pale white line. During this time, don’t be surprised if the scar becomes raised or coloured. Just perform the exercises above and try to be patient - it will eventually subside and become less apparent.

What medication will I take?

Everyone is sent home with pain relief medication. Some people don’t feel they need it and some do.

• Paracetamol and Ibuprofen – take paracetamol regularly four times a day. If more pain relief is needed, take some Ibuprofen in addition to the paracetamol. You can take the Ibuprofen up to 3 times a day with food.
• Dihydrocodeine - this is a very strong painkiller that you’ll normally be sent home with. Only take when it’s needed as taking it when it’s not causes sleepiness, headaches and constipation, so make sure your bowel habit is regular and use a laxative if needed. You can take it in addition to the paracetamol and Ibuprofen that you should already be taking.

Thyroid hormone replacement

If you’ve had a total thyroidectomy, or a completion thyroidectomy, then you will need to take thyroxine every day for the rest of your life. You should take it first thing in the morning, twenty minutes before any tea, coffee or breakfast and any other medication you take in the morning.

The dose sometimes needs altering to make you feel normal. If you miss it for a week, it won’t do any harm, but if you are taking it irregularly or stop taking it longer than a week then problems will occur and you’ll start feeling unwell. It’s a simple medication to take, but important to take correctly.

Calcium replacement

Your parathyroids have an important role controlling calcium levels, if they stop working you are at risk of developing low levels of calcium in the blood which causes a tingling sensation around your lips and finger tips. If this is left untreated, cramp and muscle weakness will develop, and if left completely untreated it can adversely affect your heart.

Even without symptoms you should take a vitamin D tablet every morning with breakfast. If you are experiencing symptoms, take the calcium tablets you have been sent home with to get rid of the tingling sensations. The tablets will either be a chewable sweet or a tablet that dissolves in water. Take the calcium tablets as often as needed to get rid of the tingling symptoms. If you are taking a lot of these they might cause constipation, which in that case you can take a laxative to encourage bowel movements.

Voice change

This can occur after any neck operation, but is often linked to thyroid and parathyroid surgery. Even though we take every effort to protect the recurrent laryngeal nerve, occasionally it can be damaged. You may find your voice is weaker, difficult to project and will tire quicker than usual.

90% of voice change is temporary and gets better within six months. If experience voice change, try these exercises to help strengthen your voice again when you feel ready:

• Make vowel sounds, holding them for as long as you can. Time yourself; if it lasts for more than 12 seconds the nerve is working normally.
• Using a straw and a glass of water, blow bubbles into the water for as long as you can.
• Press the side of your neck firmly and talk; then do the same on the other side. Try and work out if pressing one side improves your voice. If it does, then the nerve on the side that you’re pressing is the injured side.

A useful tip for coping with voice change when socialising: try sitting to the side of someone you want to talk to, so that you have to twist your head to the side of the injured nerve when talking. It will make your voice stronger and last longer.

Follow up

Thyroid and parathyroid cases are always followed up. At the meeting we can:

• Discuss the histology or diagnosis from the resected specimen.
• Review any blood results taken to see how successful the surgery was.
• Check on your thyroid function to ensure you are on the right dose of medication. This blood test can only be done eight weeks after surgery.

If you want to learn more about the treatments offered by Mr James Kirkby-Bott or book an appointment, visit his profile on the Top Doctors’ website or call  (+44) 02075 504 974