Thyroidectomy: What to Expect and How to Recover

Many people feel anxious when they find out they need to have thyroid surgery. You may wonder what to expect after thyroid removal (thyroidectomy) and how it may change your life. The good news is that most people go on to live just as they did before thyroid surgery, with a few adjustments. 

What’s a thyroidectomy, and when is it needed?

Thyroidectomy is a common and safe surgical procedure to remove all or part of the thyroid. In fact, it’s one of the most common surgeries in the world. 

For a thyroidectomy, you’ll receive general anesthesia, and a skilled surgeon will make an incision in the front of your neck. Your surgeon will identify the thyroid gland and remove what's needed to give you the best outcome possible. The amount of thyroid gland they need to remove depends on the reason for the surgery.

Your surgeon may recommend thyroid surgery for a number of conditions. The most common reasons for thyroidectomy include:

• Thyroid nodules

• Goiter

• Thyroid cancer

• Hyperthyroidism

Here’s an explanation of what these conditions are and how they relate to the surgery.

Thyroid nodules

Thyroid nodules are solid or fluid-filled lumps in the thyroid gland. They’re fairly common and not usually cancerous. As you get older, you’re more likely to develop thyroid nodules. Nodules may affect your thyroid hormone levels.

Goiter

A goiter is an overgrowth of thyroid gland tissue. They can become large enough that they affect your swallowing. Sometimes, they even affect your breathing. A goiter may also change your thyroid hormone levels.

Thyroid cancer

Thyroid cancer occurs when the cells of the thyroid gland grow out of control. Thyroid cancer can show up with swollen lymph nodes, a hoarse voice, or trouble swallowing. Sometimes, there are no symptoms at all. The course of treatment depends on the type of cancer and how far along it is.

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Hyperthyroidism

When you have hyperthyroidism, your thyroid gland is overactive. This means it makes too much thyroid hormone. Symptoms of hyperthyroidism include: 

• Weight loss

• Fast heart rate

• Increased sweating

• Anxiousness

Depending on the cause of your hyperthyroidism, your surgeon may recommend surgery as a definitive treatment.

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What happens during a thyroidectomy?

The first step for a thyroidectomy is undergoing anesthesia. The team will start an IV to prepare you for receiving anesthesia medication. Then they’ll secure your airway with a breathing tube. After you drift off to sleep, the surgeon will prepare your neck area and identify the landmarks needed to safely remove your thyroid gland. 

There are a couple of surgical approaches to thyroidectomy. Let’s take a closer look at each one:

• Conventional thyroidectomy: This technique involves a traditional neck incision, which is about 4 to 5 inches long. The surgeon will identify and secure the nerves to the larynx, the blood vessels, and the parathyroid glands. Next, the necessary portions of the thyroid are removed. Finally, the wound is closed and the dressing is applied.

• Minimally invasive approaches: Minimally invasive thyroidectomy is completed through much smaller incisions. The surgeon uses a small camera to locate the vital structures. The thyroid is freed and removed through a small midline incision that’s closed and covered with a dressing. Minimally invasive procedures have a better cosmetic outcome (meaning less scarring). Their cost is similar to other approaches. And they have similar complication rates (see below for possible complications).

How does thyroid removal affect your body?

If you have all or most of your thyroid removed, your body can no longer make enough thyroid hormone. Thyroid hormone is essential for life, and it plays a role in most of the body’s system functions. So, if you no longer have enough, you’ll need to take thyroid hormone medication. This helps replace your natural thyroid hormone. 

Without thyroid hormone replacement, you'll develop symptoms of hypothyroidism (underactive thyroid). These symptoms can include:

• Weight gain 

• Hair loss 

• Constipation

• Fatigue and lethargy

• Cold intolerance

• Dry or brittle skin

• Irregular periods and infertility

• Muscle aches, weakness, and spasms

• Depression

These symptoms usually go away when you take thyroid hormone replacement. If untreated, hypothyroidism can become life-threatening. That's why a healthcare professional will order blood tests to check your thyroid hormone levels soon after surgery and then regularly after. This is to make sure your hormone levels stay in a healthy range and you’re taking the correct dose of medication.

If you only had a small portion of your thyroid removed, there’s an 80% chance you won't need thyroid medication.

What are the most common complications of a thyroidectomy?

A thyroidectomy is a very safe operation, with a low likelihood of complications when an experienced surgeon performs it. Although uncommon, complications are possible. Complications are more likely if you have a large tumor or goiter, or if you’ve had prior thyroid surgery. 

Thyroidectomy complications can include:

• Bleeding: Bleeding in the neck may block the trachea (windpipe). This can make breathing difficult.

• Hoarse voice: Injury to one or both nerves to the larynx (voice box) can occur during surgery. This can be permanent, but it usually goes away in a few months.

• Difficulty breathing: Bleeding or damage to the surrounding nerves can cause breathing problems. This can also happen when large goiters or tumors change the shape of the thyroid.

• Hypocalcemia: This can happen from damage to the parathyroid glands, which attach to the back of the thyroid gland. They help control calcium levels in the bones and blood. Low levels can lead to tingling, muscle spasms, and sometimes seizures. 

What’s involved with thyroid recovery?

Thyroidectomy is a major surgery. And it can last a few hours, depending on how much of your thyroid you need removed. But most people recover quickly. Your surgeon will recommend that you get plenty of rest for at least 1 to 2 days after your operation. 

You’ll need to take it easy after surgery so your incision doesn’t bleed and the sutures don’t get damaged. Bleeding in the throat can cause breathing trouble if your airway is blocked. This is rare, but it can be a very serious complication.

You may be able to do some light activity within 1 to 2 days after surgery. But it can take a few weeks to resume full physical activities. Your surgeon will let you know when it’s safe for you to get back to your normal routine.

If you have a larger incision or have lymph nodes removed, it may take you longer to recover. It may also take longer if there are any complications, like:

• Hematoma (collection of blood under the skin)

• Nerve damage

• Airway obstruction

Because thyroid hormone is so important, you'll need to have your thyroid levels checked on a regular basis. If your thyroid hormone level is low, a healthcare professional may prescribe medication like levothyroxine (Euthyrox). Thyroid hormone replacement helps prevent any symptoms and complications of hypothyroidism. After adjusting the dose of the medication to get the hormone level right, most people have no symptoms. 

Your surgeon will tell you how long it’ll take to fully recover based on your overall health, diagnosis, and extent of your surgery. 

What post-operative care do you need after a thyroidectomy?

Most people can go home the same day or the day after surgery. Your surgeon will place “steri-strips” (a special type of tape) and a bandage over your incision after surgery. Your surgery team will give you instructions on how to care for the dressing and keep it clean and dry. The details will vary depending on your surgeon and the extent of your surgery. 

Here are some general guidelines you can expect:

• Pain management: Your surgeon will advise you about ice packs and pain medications, including dose and frequency. Sore throat can be treated with ice chips, cold drinks, and throat lozenges. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can be used for surgical pain. You may be given a prescription for pain medication as well.

• Wound care: Your surgical team will instruct you when to change the dressing and when you can shower. It’s important to keep the incision clean and dry until you’re given the OK to shower.

• Diet: Once you’re awake and alert, you’ll be offered ice chips and liquids. You can progress to soft foods and then to regular food as tolerated. 

• Thyroid hormone replacement: Depending on how much of your thyroid is removed and whether you have underlying hypothyroidism, you may be prescribed thyroid hormone replacement. About 6 weeks after starting thyroid hormone, your prescriber will likely check a blood test to see if they need to adjust the dose.

• Calcium supplementation: The parathyroid glands are attached to the back of the thyroid. They help control calcium balance in the blood. Your surgeon will check for symptoms of low calcium (such as tingling or muscle cramps) and check your calcium levels. You may need to take a calcium supplement and vitamin D if your parathyroids aren’t working. Parathyroid function usually returns to normal in a few weeks to months.

• Activity restrictions: You should avoid strenuous activity, heavy lifting, and coughing for several weeks after thyroid surgery. If your job doesn’t require strenuous manual labor, you should be able to go back to work in a week or two.

Your surgery team will also make an appointment for you to return to their office. This is usually within 1 to 3 weeks to check how you’re healing. If you have any concerns in the meantime, contact your surgeon’s office right away. These include complications like:

• Swelling

• Bleeding

• Fever

• Drainage from the incision

• Trouble breathing 

If your thyroid removal was to treat cancer, your follow-up care may involve more frequent labs, tests, or X-rays. Your healthcare team may want to see you as often as every 6 months.

Can you live a normal life after thyroid removal?

Most people return to their normal lives and usual activities within a few weeks after thyroidectomy. If you have cancer, surgery may be the only treatment you need. If surgery isn’t expected to cure the cancer, you may need to have other therapy, such as radiation.

You’ll likely have regular blood tests, depending on how much thyroid tissue you have left. And you may also need to take thyroid hormone replacement to prevent complications. But most people are able to continue their usual routines — with the adjustment of periodic lab tests and daily medication.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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