Thyroidectomy - My Experience
We all have one, but we don't pay attention to it. Seriously, when's the last time you thought about your thyroid? Do you even know where it is? Of course you do, its in your throat. Actually, its below your Adam's Apple in front of your windpipe. Did you know it has two sides and is shaped like a butterfly?
It also has lots of nerves and your vocal cords are located really close to it. Growth, development, and body temperature are regulated by thyroid hormones. It is one of the glands in the endocrine system, the body's control system.
Thyroid hormones increase the rate of cellular metabolism, how fast you burn calories, and how fast your heart beats . The thyroid hormones are T3, T4, and calcitonin. You may also have heard of TSH. TSH is thyroid-stimulating hormone which regulates the T3 and T4. T4 is converted to T3 which is used by various organs in the body. Iodine is also necessary to help regulate the thyroid. In parts of the world where there is no iodine, enlarged thyroids called goiters, are common. This is probably as clear as mud, however, if there is an imbalance of these hormones your body is in trouble and often, you don't even know it.
Signs of Thyroid Problems
The main types of thyroid problems are overactive and underactive. At least those are the main ones we hear about. This is a run down in a nutshell, certainly not a comprehensive look.
An overactive thyroid is often referred to as Hyperthyroidism, a condition where the thyroid produces too much thyroid hormone. When this happens your body's processes can speed up and you may experience nervousness, your heart may speed up, you may get sweaty, have trouble sleeping, or any number of other symptoms. Doctors don't always pin point hyperthyroidism as the cause of your problems. Medications can be prescribed but if these fail radioactive therapy may be prescribed.
An underactive thyroid is often referred to as Hypothyroidism, a condition where the thyroid produces too little thyroid hormone. When this happens your metabolism slows down. You may become tired, irritable, have dry skin, hair loss and more. Hypothyroidism is actually very common, especially among women. I'm not sure which comes first here, the chicken or the egg i.e. do nodules cause hypothyroidism or does hypothyroidism cause nodules? Either way they often go hand in hand.
Both overactive and underactive thyroids can be treated with medication. When medication does not do the trick and radioactive iodine therapy is not indicated, surgery is the only alternative. I know because I was scheduled for surgery.
Steps to Thyroid Surgery
Thyroid surgery is not done lightly. I had an underactive thyroid for about twenty years. I took synthroid and had my thyroid monitored meaning, I had sonograms done every six months to a year. Along with my underactive thyroid I had bilateral nodules that recently showed they were growing each time I had a sonogram. Additionally, my thyroid was enlarged (sometimes called a goiter). I also had two fine needle biopsies done over the years to rule out cancer.
A few months ago when I got the results of my latest biopsy my doctor informed me I needed another biopsy. These biopsies are painful. I asked him why we needed another one now and he said both the nodules and my thyroid had grown considerably. My thyroid was now three times its normal size. No one I know wants to have surgery, however, as the nodules and thyroid were continuing to grow and I wasn't getting any younger I thought perhaps surgery should be considered. My doctor said certainly, now would be a good time to take it out.
I then went to an endocrine surgeon. All he does is thyroid removal and specialized endocrine surgery. He said I could continue with the medication I was taking or remove the thyroid. When I posed the same situation to him he recommended removal. Step one, schedule an appointment for pre-op surgery.
The pre-op surgery appointment consists of a general check-up together with bloodwork, and a family history. Depending on your age, and EKG may be necessary. Normally surgery takes place two weeks later, but I had a bad cold so surgery was postponed. Three weeks later I went back, still had the cold, and surgery was again postponed. On my third pre-op visit and second EKG and set of bloodwork I was finally cold free and scheduled for surgery.
Step two, surgery. I was told the surgery would take between two and two and a half hours followed by some time in the recovery room before being brought to my room. I remember leaving the surgical prep area and being wheeled down the hall. The next thing for me, was waking up in my room. So I can say without a doubt, the surgery was no problem for me. However, when I was back in my room the fun began. I'm not sure which hurt more, my throat or my head. The nurse explained that often a patient's head hurts from the positioning of the head during surgery. Your throat hurts from the surgery but also from the large tube placed down your throat during surgery.
My incision is a little over three inches long (thank you Doctor!) According to WebMD the standard incision size is four to five inches long. While this is not a dangerous surgery in itself, there are two things the surgeon must be very careful with, the vocal cords and the parathyroid glands. The need to prevent damage to the vocal cords is obvious, your voice would be damaged if your vocal cords were. The parathyroids on the other hand are not as well known. These glands regulate the amount of calcium in the blood and are very important! Fortunately damage to either of these important structures is rare especially in the hands of a practiced surgeon.
To give the parathyroids time to recuperate, you may be prescribed large doses of calcium. My doctor chose to additionally give me calcitonin due to my age. Calcitonin is a naturally occurring hormone that helps regulate the calcium in your body. Taking the calcium supplements is usually recommended for five days, to feed and make sure the parathyroids are working. During that five days you have to have two blood tests spaced over the five days. I have heard of younger people who were prescribed calcium or even Tums with calcium before their surgery. The objective of the blood tests is to make sure the calcium is being regulated.
After the Surgery
Once the surgery is over, you've rested in the hospital overnight with special pain meds to get you through the night, you are then sent home. When you get home and look in the mirror you may be a little taken aback. There was no bandage on my throat. A skin glue closure was used and I was told the internal sutures would dissolve. So I was looking directly at the incision. It was kind of ugly, raised, bruised (black and blue), a lump under the incision, and of course the incision itself.
The body is a miraculous machine however! While you originally feel like you have the world's worst strep throat and swallowing will kill you, within just a few days you can swallow without that sharp pain! The headache is gone in a day or two. The stiffness and soreness in your neck, around your throat, may take a few days to go away. For the first three days after my surgery Tylenol was my best friend. I did not fill the prescription for the narcotic/stronger medication, didn't want it, didn't need it! I did have some difficulty swalling the huge calcium pills but I survived.
My voice was a bit hoarse but nothing to be alarmed about. There were no diet restrictions. If you could eat it, go ahead. Forty-eight hours after surgery I could shower without allowing the shower to beat directly on my throat. I was told once I could turn my neck without pain I could drive.
Its been almost two weeks since my surgery. I'm pretty much back to normal with a few exceptions. The incision is still very sore. If I raise my head to look up it pulls on the incision and hurts. If I laugh too hard, it hurts, but other than that I'm doing really well. I'm not sure if the fatigue is from the surgery or my new dose of synthroid, but we'll work that out I'm sure.
I go back to the doctor for my two week post op on Tuesday. I'll find out a few additional things then, but I'm pretty much on my own. The only thing is the incision and its remaining scar. It will be sun sensitive for a year. Yes, a full year. Covering it (until the sensitivity goes away) then loads of sunscreen on the incision area will prevent it from being a dark ugly scar in the future.
All in all this surgery was not as bad as I thought. Scary? Of course but there could be a lot worse. If you're schedule for this surgery, relax, listen to your doctor, and good luck.
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Surgery PhotosClick thumbnail to view full-size
Post Op Visit
My post op visit went very well. I saw the Physician's Assistant I had seen for my pre op visit. She was very friendly, pleasant, and helpful. She removed the dermabond that was over the incision. It was a little uncomfortable but not bad. The dermabond was the reason there was no visible bandage over the incision and added to the unsightly appearance. One of the internal sutures had made its way outside of the skin so she tugged on it and cut it. I have to admit that was a bit painful, but not for long. That night I was sore and had to take a Tylenol, but not bad all in all.
Residual swelling will take about three months to go away as well as the feeling there's a golf ball in my throat. Not at all painful but uncomfortable when swallowing. She said to remember a lot of tugging went on during surgery to cause the swelling.
Adjustment to my Synthroid may take three months, or may not depending on my body. We'll see.