Surgical Procedures Post-op Instructions

Below are general instructions for patients who have had thyroid or parathyroid surgery. Since individual circumstances may vary, it is important that you discuss your individual post operative care with your surgeon.

Monitoring Your Progress

You should feel improvement every day after surgery. If you have any questions regarding your progress, call your surgeon. In fact, a phone call to your surgeon's office the first 2 days after your surgery to report how you feel can help your surgeon monitor your condition. Your surgeon will instruct you to make a follow up appointment approximately 2 to 3 weeks after your surgery.

Incision

Your incision is covered with a protective strip of clear glue called collodion. You can shower and wash your hair as usual, but do not soak or scrub the incision. After showering, use a cool hair dryer to dry the incision. The collodion will turn white and start curling up at the edges in about 4 or 5 days. When this happens, you can pull it off or wait until it falls off on its own. If you experience itching once the collodion is off, you may apply lotion to the scar. You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright. In addition, the scar may become pink and hard. This hardening 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.

Thyroid Hormone Tablets

If you were taking thyroid hormone tablets before your operation, continue with the same dose, unless your dose is changed by your surgeon. If you were not taking thyroid hormone prior to your operation, your surgeon may prescribe these tablets following surgery. During your post operative visit, you may have a blood test to measure your levels of thyroid hormone and your dose of medication may be adjusted accordingly. Your thyroid hormone levels will then be measured about every 2 months until your hormone levels are stable (levels generally stabilize in 4 to 5 months).

Pain

The main complaint following thyroid surgery is pain with swallowing. Some people experience a dull ache, while others feel a sharp pain. This should not keep you from eating anything you want, but the pain can be annoying for a day or two. Toradol, Motrin or Tylenol is generally enough to control this pain. Some people prefer Tylenol with codeine, but in general, strong medications are not necessary or advisable.

Voice

Your voice may go through some temporary changes with fluctuations in volume and clarity (hoarseness). Generally, it will be better in the mornings and "tire" toward the end of the day. This can last for variable periods of time, but should clear in 8-10 weeks at most. If you are hoarse, speak to your surgeon about what you can expect.

Cough

If your operation was done under general anesthesia, you may feel like you have phlegm in your throat. This is usually because there was a tube in your windpipe while you were asleep that caused irritation that you perceive as phlegm. You will notice that if you cough, very little phlegm will come up. This should clear up in 4 to 5 days.

Hypocalcemia

In about 8% of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery. This is usually temporary and causes the blood calcium level to drop below normal (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.

Hypocalcemia is treated with calcium tablets, specifically 2 tablets of Oscal 500. It is a good idea to purchase Oscal tablets before your surgery so that you have it in your home. If you feel you need it, take the calcium (there is no danger in taking Oscal even if you do not need it) and then call your surgeon to confirm your need. The symptoms of tingling/numbness should improve within 20 to 30 minutes of taking the tablets.

Once you start taking the calcium, you should repeat the dose whenever the symptoms return. This may mean that you are taking as many as 2 tablets every 3 hours. It is important that you keep your surgeon informed. The hypocalcemia should disappear in 7 to 10 days. If it does not, tell your physician.

Bone Health

Patients who are taking thyroid hormone tablets or who have a history of parathyroid disease should take 1000 - 1200 mg of calcium daily and 200 to 400 IU of vitamin D daily to promote healthy bones. In addition to these supplements, an exercise routine using weights is also recommended.