In general, patients should be eating, drinking, walking around, and doing their normal activities the night of the operation. However, patients will be asked to do no heavy lifting, swimming, or soaking in a bathtub for 1 week after the operation. Patients should call their surgeon's office to make a follow up appointment approximately 2 to 3 weeks after surgery.
Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Some people experience a dull ache, while others feel a sharp pain. The Thyroid Center recommends taking Tylenol, Motrin, or Advil as the bottle directs around the clock for the first few days (as long as their overall health allows it). Patients will be sent home with a prescription for a mild narcotic medication, but many patients do not need to use it. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days.
The incision is covered with a protective strip of clear glue called collodion. The collodion will turn white and start curling up at the edges in about 7 to 10 days. When this happens, it can be peeled off or one can wait until it falls off on its own. If there is itching once the collodion comes off, lotion can be applied to the scar. If the patient is going out into the sun, we recommend putting sunscreen or sunblock on the incision so that it tans evenly. Patients may apply whatever they like to the incision as long as it does not irritate the skin. In general, most patients do nothing and the cosmetic results are excellent. Patients can shower the day after the operation, but do not soak or scrub the incision. After showering, use a cool hair dryer to dry the incision. There may be bruising around the incision or upper chest and slight swelling above the scar when sitting up or standing. In addition, the scar may become pink and hard. This hardening is part of the normal healing process, will peak at about 3 weeks and may result in some tightness or difficulty swallowing, which will disappear over the next 2 to 3 months.
Bleeding is a rare complication and those few patients who do have a bleeding problem almost always have it during the 6 hour observation period in the recovery room. However, in the first 24 to 48 hours, patients and their family/friends should observe the incision and neck for signs of bleeding in the neck such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to get bigger, and a feeling that something bad is happening. If any of these symptoms happen, the patient should call 911 first and then their surgeon.
In general, patients may resume taking their normal medications the day after the operation. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. Patients should discuss with their doctors when and if they should restart these medications. Typically, patients will be given prescriptions for two medications after the operation:
Pain medication: A mild narcotic medication will be prescribed. We recommend trying non-narcotic medications like Tylenol, Motrin, or Advil first and if the patient is still having pain, then trying the narcotic medication.
Calcium: All New York Thyroid Center patients will be sent home with a prescription for calcium pills. This calcium prescription is to help prevent patients from having symptoms of low blood calcium levels. Patients will be asked to take calcium as follows: Calcium 1000 mg every 6 hours for 7 days after the operation, followed by Calcium 500 mg every 12 hours until they are seen in the office 3 weeks later.
Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). If the patient was taking thyroid hormone before the operation, they should continue taking the same dose unless it was changed by the surgeon. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. The dose of thyroid hormone is usually based on the person's weight. During the post operative visit, a blood test called TSH level may be checked to measure the levels of thyroid hormone in order to determine if the dose is correct. Thyroid hormone levels will then be measured about every 2 months until the hormone levels are stable (levels generally stabilize in 4 to 5 months).
Most patients (97%) have no problems with their voice immediately after the operation. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). In these cases, the voice will often be better in the mornings and "tire" toward the end of the day. Hoarseness generally improves within the first 3 to 4 weeks after the operation but it may take up to 6 months. Patients should not be worried about hurting their voice by talking. If the voice is still hoarse after 3 to 6 months, the surgeon may prescribe voice-strengthening exercises or ask the patient to visit with a voice specialist for evaluation.
In about 5% of patients who have thyroid surgery, the parathyroid glands may become stunned. This stunning causes the blood calcium levels to drop below normal (i.e. hypocalcemia). Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours.
In order to avoid the symptoms of hypocalcemia, New York Thyroid Center surgeons prescribe calcium post-operatively for all patients having thyroid surgery. If patients are still having symptoms after taking the calcium as prescribed, they should take an extra 1000 mg of calcium. If the symptoms do not improve after 30 minutes, they should call their surgeon. At this point, the surgeon may prescribe a form of vitamin D called Calcitriol or Rocaltrol. This medication helps the body absorb more calcium.