Thyroid Surgery Basics with FAQ & What to Expect After the Procedure
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Thyroid Surgery Basics with FAQ & What to Expect After the Procedure

No one wants surgery but sometimes it's necessary. 

This post will walk you through everything you need to know as a patient about thyroid surgery. 

You'll learn what conditions it is recommended to treat, the complications of the surgery, why some people gain weight afterward and what you can do to prevent this side effect:

More...

Why Do People Need Thyroid Surgery? 

The main reason why you would undergo thyroid surgery is that there is something wrong with your gland that can't be fixed through other means. 

In most cases, surgery, of any organ or tissue, is considered the last possible resort. 

The best option is to try and fix whatever issue is happening in your body with other less invasive measures before you resort to simply "taking it out". 

But, even with the best intentions, it's not always possible and you may ultimately require thyroid surgery. 

But what conditions absolutely require that your thyroid be removed? 

The most common condition that results in the removal of your thyroid gland is thyroid cancer or a high suspicion for cancerous cells in your thyroid gland. (1)

Thyroid surgery (usually a complete thyroidectomy) is usually considered to be the single best (and sometimes only) therapy required to treat thyroid cancer. 

But other conditions such as very large thyroid nodules (2) or a very large thyroid gland (thyroid goiter) (3) may also necessitate removal. 

Lastly, conditions that result in excessive thyroid hormone production (known as hyperthyroidism) (4) may also necessitate the removal of your gland. 

Conditions that fit into this category include hyperthyroidism, toxic nodules and Graves' disease. 

In most cases, your Doctor will not recommend thyroid surgery unless it is absolutely necessary!

But that doesn't mean that you shouldn't read more to learn and understand what is happening in your body. 

Undergoing surgery is a permanent procedure and there may be other therapies available to you which would be worth exploring if you haven't already. 

You can read more about alternatives below. 

What to Expect After Surgery

If you are expected to undergo thyroid surgery then what can you expect after the procedure?

We'll talk more about the potential risks and side effects of the procedure but first I want to focus on the repercussions of removing an endocrine gland from your body. 

Your thyroid gland produces some of the most powerful hormones in your body, these hormones are known as T3 and T4

They are produced directly from the thyroid gland which sits in your neck. 

After they are produced they travel in your bloodstream to nearly every cell in your body where they help to increase your energy, manage your metabolism, (5) manage your mood, control your heart rate (6) and much more. 

Thyroid adrenal reset complex 400 x 350

I bring this up because it's important to realize that once you remove your thyroid gland then this system will no longer work in the exact same way as it did in your "natural state"

Once you have removed your thyroid gland you still have the requirement for thyroid hormone in your body but it can no longer be produced naturally. 

As a result, Doctors will prescribe a thyroid hormone medication replacement that you will need to take for the rest of your life. 

This process sounds simple, but it can be complex when it comes to finding out the "right dose" for your body. 

The exact type and dose of thyroid medication depend on a number of factors and may require time and titration to figure out. 

Most of the negative side effects that people feel after their procedure (7) are directly related to thyroid function in their body. 

Luckily, this can be addressed with the right physician and with certain blood tests. 

Potential Complications & Side Effects of Thyroid Surgery

As far as surgeries go, thyroid surgery is generally a very well tolerated operation which has a low incidence of complications. 

The thyroid gland sits very close to the surface of the skin so it is relatively easy to get to without large or deep incisions. 

picture of the parathyroid gland in relationship to the thyroid gland

Having said that, it's worth exploring some of the potential consequences of thyroid surgery (or what can go wrong). 

  • Low calcium from damage to the parathyroid glands (8)- Your parathyroid glands rest very close to your thyroid gland and can sometimes be damaged or removed during surgery. Your surgeon will do his or her best to NOT damage these glands, but despite best efforts, they may still be removed or damaged. The parathyroid glands help to regulate calcium in your body, so if they are removed you may suffer from low calcium (also known as hypocalcemia) (9) after the procedure and may require calcium supplementation for the rest of your life. The incidence of this complication after thyroid surgery is estimated to be between 7% and 34% (depending on which study you look at) (10). 
  • Vocal cord issues - The recurrent laryngeal nerve (which helps control your voice) runs very close to the thyroid gland and may be accidentally damaged during thyroid surgery. Damage to this nerve may result in hoarseness or changes to your voice. This is particularly important if you are a professional singer or use your voice as part of your career and should be considered in such cases. The incidence of damage to this nerve varies from around 0.4% to 7.2% depending on which study you look at. (11)
  • Infection/bleeding complications - All surgeries come with a small risk of bleeding after the operation or infection at the surgical site. This risk isn't special to thyroid surgery but it should always be considered. 

All in all, the risk of serious complications relating to thyroid surgery are typically less than 2%. 

Thyroid Surgery FAQ

Still have questions? 

Use this FAQ below. 

Should I Undergo Thyroid Surgery or Try Other Options First?

If at all possible it would be worth exploring other options before you have your thyroid removed. 

Once your thyroid is removed you will be reliant upon taking thyroid medication orally (by mouth) for the rest of your life. (12)

Even though you can survive with thyroid medication, it can be difficult to truly thrive and get back to your normal self. 

This has to do with the fact that we are not able to completely provide your body with the exact same amount of hormone as your body can produce naturally (assuming normal thyroid function). 

This difference can sometimes cause weight gain, fatigue and other symptoms in post thyroidectomy patients (those who have their thyroid removed). 

What alternative therapies are available to you depend on why you need to get your thyroid removed. 

For instance:

Thyroid cancer patients do not have the luxury of alternative options because the risk of keeping in your thyroid outweighs any potential benefit. 

On the other hand, in conditions like hyperthyroidism, you may be able to try alternative medications or integrative therapies to attempt to avoid thyroid surgery. 

If you aren't sure what is best for you don't be afraid to seek out a second opinion from another physician!

You will find that many Doctors do not think the same way and there may be other options available to you. 

How Long Will it Take me to Recover?

Most people bounce back from thyroid surgery within 1-2 weeks. 

Your thyroid gland is very superficial which means that your surgeon won't have to cut very deep to get to your thyroid. 

This means that your recovery is often quite rapid. 

After your surgery, depending on the amount of thyroid tissue removed, you will probably be placed on thyroid hormone replacement therapy.

Do I have to take Thyroid Medication After?

In most cases, you will be placed on thyroid medication after your surgery. 

If you have your entire thyroid gland removed (known as a complete thyroidectomy) then you will be required to take thyroid medication afterward. 

Other surgeries, such as partial removal of your thyroid gland, may not require thyroid hormone replacement therapy. 

Your Doctor will be able to check your thyroid function through routine blood work after the procedure to determine if you need thyroid medication. 

If you begin to feel symptoms such as fatigue, constipation, hair loss, weight gain and so on, these may be signs that you need thyroid medication. 

These symptoms may be an early sign that you are hypothyroid (or have a condition in your body in which you aren't able to produce enough thyroid hormone). 

Will I gain Weight After the Procedure?

Your Doctor may try to tell you that you will not gain weight after your procedure, but many studies have shown the exact opposite. 

Studies have shown that people who undergo treatment for hyperthyroidism tend to gain weight. 

People who undergo a thyroidectomy (complete removal of the thyroid gland) gain more than other therapies with an average of around 8-12kgs or 18-26 pounds. (13)

Not all people who undergo thyroid surgery will gain weight, however, so don't let it be a cause of anxiety. 

Certain people, such as those who go into their surgery already overweight, tend to gain more weight than those who go into their surgery at a normal weight. 

But why do patients tend to gain weight?

There is a lot of controversy surrounding this exact topic but I believe it to be the cause of insufficient thyroid hormone replacement and the reliance upon TSH as the sole marker for thyroid status in the body

Most people, provided they are able to get on appropriate thyroid medication after their treatment, should not gain weight after surgery. 

Do I have other options?

The answer is maybe. 

You can use the treatment chart below to help you determine if you have other options.

Treatment options available for hyperthyroidism (including toxic nodules, Graves' and other causes):

  • Thyroid blocking medications - Medications such as Methimazole or PTU can block the production of thyroid hormone in your body. These medications do come with side effects but they may be preferred over the potential side effects of thyroid surgery. 
  • Integrative/alternative therapies - It is always worth a trial of dietary changes and the use of certain supplements to see if you can manage your disease with lifestyle changes. You can read more about those here
  • RAI (radioactive iodine ablation) - This procedure results in destruction of the thyroid gland without surgery but is not without side effects. It may be an option over thyroid surgery depending on your specific situation (you can discuss this with your doctor). 

Treatment options available for thyroid cancer

  • Thyroid surgery is generally recommended as the primary treatment for thyroid cancer.

Treatment options available for thyroid nodules:

  • Watchful waiting (sometimes you can get away with simply monitoring your thyroid nodule). 
  • If your nodule is large enough to cause symptoms such as vocal cord changes or difficulty breathing then you may need to get it removed. 
  • If there is any risk that your thyroid nodule is cancerous then you will need to undergo a biopsy and potential removal with thyroid surgery.

Will I be Normal After the Procedure?

Yes!

Most people are able to live a normal life after their procedure. 

Some people may experience the side effects we discussed above (such as fatigue, weight gain, brain fog, etc.) but these symptoms can be treated with thyroid medication. 

How Big is the Scar?

The scar associated with thyroid surgery is usually not very big and depends on the size of your thyroid gland and the type of surgery you need. 

For minimally invasive thyroid surgery the scar may be as small as 2.0-2.5cm (which is about an inch). 

If you require additional removal of tissue such as lymph nodes in the neck then your scar may be larger. (14)

Most surgeons are great at "hiding" the scar associated with this procedure by placing it in the folds of your neck. 

Scars are not even noticeable in some people after their procedure. 

How Should I Find my Surgeon? 

One of the best ways to find your surgeon is to get a recommendation from another person who has had the same operation. 

If you can find other patients who have had success with specific surgeons then you can feel confident you are getting a good surgeon. 

You might also find success in looking for surgeons who specifically specialize in thyroid related surgeries and not a surgeon who is a more "general surgeon". 

You'll want to find a surgeon who performs thyroid surgeries on a routine basis. 

You may also have success by asking your endocrinologist who he or she recommends. 

There is a good chance that your endocrinologist has referred many patients to specific surgeons and knows which ones are the best. 

Try to avoid going to whichever surgeon your insurance recommends as this may not be the best one for you! 

What is the Difference Between a Complete Thyroidectomy and a Hemithyroidectomy? 

A complete thyroidectomy is the entire or complete removal of your thyroid gland. 

In reality, it's actually impossible to remove 100% of your thyroid gland (even though that is the goal) but that is beside the point right now. 

A hemithyroidectomy is a procedure in which only half of your thyroid gland is removed. 

If you have your entire thyroid gland removed then you will absolutely need to be on thyroid medication for life. 

If you have only part of your thyroid gland removed then you may not be required to be on medication for life. 

Conclusion

If you are considering undergoing thyroid surgery then make sure that you explore all of the options available to you. 

Thyroid surgery is usually a very well tolerated procedure, but the act of taking out an organ which produces hormones can sometimes be difficult on the body. 

In some situations, such as thyroid cancer, the procedure must be done. 

But in other situations, you may have alternative options. 

If you are ever unsure of how to proceed don't be afraid to seek out a second opinion from another Doctor!

Now I want to hear from you:

Have you undergone thyroid surgery?

Are you considering undergoing the operation?

How have you tolerated the procedure? Do you feel like yourself?

Leave your comments below! 

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

Click Here to Leave a Comment Below 15 comments
Neysha - June 25, 2018

I had a complete removal of my thyroid. It has taken three years of adjusting my medicines. My endroconologist gave up on me. I finally began researching why my numbers weren’t in range and why I felt horrible. Took all my research to my general dr. She listened. Began taking armour thyroid which has T3 in it. Within a month began feeling better. Still working on my dosage but finally feel human again. It can be a struggle.

Reply
    Westin Childs - June 25, 2018

    Hi Neysha,

    I definitely agree! Unfortunately, it can be difficult to feel “normal” after the procedure but it can be done with the right approach. Thanks for sharing!

    Reply
Randee Bryner - June 26, 2018

Hi Dr Childs, I’ve had two parathyroid surgeries. My mom, two of my brothers and my daughter have also had the same surgeries. Unfortunate my mom passed away from Zollinger Ellison Syndrome. After her passing her Dr suggested that we be tested for MEN1 (Multiple Endrocrine Neoplasia 1. We all tested positive. So many Drs have never heard of this. Are you familiar with other?

Reply
    Westin Childs - June 26, 2018

    Hi Randee,

    Yes, I’m familiar with MEN syndrome.

    Reply
Bethany Birchridge - June 26, 2018

Thyroid problems run in my family, so I’ve been worried that one day I’ll need surgery. I like how you mentioned that a thyroid is not recommended to be removed unless it’s necessary. I’ve heard that sometimes large thyroid nodules can press against arteries and veins, cutting off blood to your brain. Is this true?

Reply
    Westin Childs - June 26, 2018

    Hi Bethany,

    It’s possible but they have to be very large to get to that point!

    Reply
    Tara - June 26, 2018

    Bethany: I had a 5cm nodule sitting directly between my carotid artery and jugular vein. Needless to say, my docs were anxious to get it out. It was also fast growing. So make sure you keep up on getting your ultrasounds done. 🙂

    Reply
Tara - June 26, 2018

Hi Dr. Childs. I just wanted to say that your site has been invaluable to me! So much good information that my endocrinologist dismisses. He insists my weight is only about calories in/calories out, and says hormones have nothing to do with it. Needless to say, I’m searching for a new doctor.

I was diagnosed with thyroid cancer in 2009, when they removed my entire thyroid. In 2015, I had a recurrence of cancer with 5 nodules in my thyroid bed, which they also removed. I’ve always been overweight (PCOS/insulin-resistance), but now it’s worse. On top of that, I had a total hysterectomy at the age of 44.

I’m getting ready to purchase your 60-day nutrition program and hope that it makes a difference. I’m a third-degree black belt in kung-fu, and work out several times a week, and eat under 1700 calories, but cannot lose weight. Thanks again for this wonderful site. I hope that it can help me. 🙂

Reply
    Westin Childs - June 26, 2018

    Hi Tara,

    No problem and glad you find it helpful! Learning is the first step to fixing the problem so it sounds like you are on the right track!

    Reply
ola - June 29, 2018

I had near total thyroidectomy 3 months ago, since then have not been taking any medications and everything seems normal.

Reply
    Westin Childs - June 29, 2018

    Hi Ola,

    If your Doctors felt it was necessary to start medication they probably would have done so by now. They must believe that you have sufficient thyroid function left after the surgery.

    Reply
Kathy Ruscher - July 9, 2018

I had my thyroid gland removed in 2015 due to multi-nodular goiter. I began taking levothyroxine for hypothyroidism and felt terrible even though blood labs said my levels were in range. After a lot of searching I’ve recently found a doctor willing to prescribe natural dessicated med and after 6 weeks I’m feeling better. Currently taking 60 mg daily. I’m wondering if sustained release T3 can be taken with my current med and if so do I need a prescription to get sustained release T3?

Reply
    Westin Childs - July 9, 2018

    Hi Kathy,

    Yes, SR T3 can be combined with NDT (I have many patients on that combo) but you will need a prescription from your Doctor to get it.

    Reply
Teressa - August 2, 2018

I’ve been hypothyroid for ten years. With many goiters. And Hashimoto’s disease. Just had a partial thyroidectomy yesterday. While the incision is in the folds of my chin I also have a drain tube 1/2 under the incision. I question that and how well that will heal? Since I was already hypo will I see much decrease in my “normal” state? I had in February surgery for gallbladder removal, hiatal hernia repair, and gastric bypass. Have lost 50 pounds with 25 to go. This should help in gaining additional weight shouldn’t it?
Thanks for your reply.

Reply
    Westin Childs - August 2, 2018

    Hi Teressa,

    I’m sort of confused by your question but if you’re asking if taking our thyroid out may result in weight gain, then the answer is yes it might. Also, the incision should heal fine in the folds of your neck and this is a common way that surgeons hide surgical scars.

    Reply

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