About Your Surgery
The thyroid gland is a small, butterfly shaped gland in the lower part of the front of your neck (see Figure 1). It consists of 2 lobes. Your thyroid produces hormones that control the way your body turns oxygen and calories into energy.
Lymph nodes are small oval or round structures found throughout your body. They make and store cells that fight infection.
Your parathyroid glands lie behind your thyroid. They produce a hormone that helps to maintain the level of calcium in your blood.
This guide will help you prepare for your thyroid surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
During your thyroid surgery, all or part of your thyroid gland will be removed. The surgery is done through an incision (surgical cut) in the lower part of the front of your neck. Your surgeon will examine the whole thyroid gland. He or she will decide how much of the gland needs to be removed and will check the lymph nodes that lie next to your thyroid.
- If half of your thyroid is removed, it is called a lobectomy or hemi-thyroidectomy.
- If your entire thyroid is removed, it is called a total thyroidectomy.
Your surgery will take 2 to 3 hours.
Figure 1. Your thyroid gland
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.
- If you use alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.
Presurgical Testing (PST)
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery.
It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Complete a Health Care Proxy Form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. This person is known as your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Identify Your Caregiver
Your caregiver plays an important role in your care. He or she will learn about your surgery with you from your healthcare provider. Your caregiver will need to be present after your surgery for the discharge instructions so that he or she is able to help you care for yourself at home. Your caregiver will also need to take you home after your surgery.
Stop Taking Certain Medications
If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
You will need to have the following medications once your are home after your surgery:
- Calcium supplement such as calcium carbonate (Tums Ultra®)
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil®, Motrin®), and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive for your surgery. If you are scheduled for surgery on Monday you will be called on Friday. If you do not receive a call by 7:00 pm, please call 212-639-5014.
Go to bed early and get a full night’s sleep.
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 2).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
Take Your Medications as Instructed
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Do not put on any lotion, cream, deodorant, make-up, powder, or perfume.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
- Sneakers that lace up. You may have some swelling in your feet; lace-up sneakers can accommodate this swelling.
- Your portable music player, if you choose. However someone will need to hold it for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Once You’ve Arrived for Your Surgery
You will be asked to state and spell your name and birth date many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Surgery
You will be given a hospital gown, robe, and non skid socks.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area.
You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.
Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your stay and after you leave. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU) or your
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You may have a drain in your neck under your incision. It is usually removed the day after surgery.
Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, please read How to Use Your Incentive Spirometer.
Will I have pain?
You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to treat your pain as needed. If your pain is not relieved, please tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.
You will be given pain medication through your intravenous (IV) catheter at first. When you can swallow liquids, you will get your pain medication by mouth. You will be given a prescription for a mild pain medication before you go home. You may want to take extra strength acetaminophen (Extra Strength Tylenol®) instead. Ask your nurse or doctor when to take other over-the-counter pain medication.
Will I be able to eat after surgery?
You can begin to take ice chips and liquids several hours after your surgery. It is normal to feel some discomfort while you are swallowing. You will slowly progress to a regular diet. There will be no dietary restrictions after the first night.
Will I have pain when I am home?
The length of time each person has pain or discomfort varies. You may still have some pain when you go home.
You will be given a prescription for a mild pain medication before you go home. You may want to take extra strength acetaminophen instead.
Call your doctor if the medication prescribed for you doesn’t relieve your pain.
Can I shower?
You can shower 48 hours after your surgical drain is removed. If you did not have a drain, you can shower 48 hours after your surgery.
Do not tilt your head upwards during your shower for 4 weeks after your surgery. Let the water run over your incision line. Gently pat your incision line dry with a clean towel or wash cloth. Call your doctor if you see any redness or drainage from your incision.
Do not take tub baths until you discuss it with your doctor at the first appointment after your surgery.
How do I care for my incision?
Before you go home, your nurse will teach you how to care for your incision. These instructions will be written in the paperwork you will receive when you leave. In most cases, your staples or stitches will be removed during your first appointment with your doctor after your surgery.
The location of your incision will depend on the type of surgery you had. It is normal to have numbness of the skin below the incision because some of the nerves were cut; this sensation will lessen over time.
- By the time you are ready to leave, your surgical incision will have begun to heal.
- You and your caregiver should look at your incision with your nurse before you leave so you know what it looks like.
- If any liquid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision.
Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incision, they can be left uncovered.
If you go home with Steri-StripsTM on your incision, they will loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them.
If you go home with glue over your sutures (stitches), it will also loosen and peel off, similarly to the Steri-Strips.
What medications will I need to take?
If your entire thyroid gland was removed, you will need to replace the hormone your thyroid used to produce. You must take it every day for the rest of your life. There are many thyroid hormone medications. Your doctor will prescribe one for you and tell you how much to take. You may also need blood tests to make sure you are getting enough, but not too much of the medication. Your doctor will change the dose as needed.
Your doctor will tell you if you also need to take calcium supplements. You can buy them at your local pharmacy without a prescription. Ask your doctor how much you should take. If you are taking calcium, your doctor may also want you to take vitamin D to help your body absorb it.
Calcium can cause constipation, especially while you’re also taking pain medication. If you think this might be a problem for you, talk with your nurse. A stool softener or laxative may be recommended.
When is it safe for me to drive?
You may resume driving 1 week after surgery as long as you feel comfortable turning your neck to look for traffic.
When can I lift heavy objects?
Check with your doctor before you do any heavy lifting. Normally, you should not lift anything heavier than 10 pounds (4.5 kilograms) for at least 2 weeks. Ask your doctor how long you should avoid heavy lifting.
What exercises can I do?
Do not use weights or machines on your upper body for at least 4 weeks after your surgery. You can do lower body exercises.
Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed.
Ask your doctor or nurse before starting more strenuous exercises.
What other restrictions will I have?
For at least 4 weeks your surgery, do not tilt your head backward (as in looking up at the ceiling). This pulls on your incision. You can move your neck from side to side and downward.
For the first year after your surgery, avoid having the sun on your incision site. Your doctor or nurse will tell you when it’s safe to use sunscreen, but it’s usually when your incision has closed completely.
How long will it take for me to recover?
You will notice a gradual return of energy in the weeks after surgery. Some people find that their energy level varies for a month or 2.
My incision feels tight, is that normal?
You may feel tightness along your incision as it heals. This feeling can come and go. It can last from a week to more than several months. It is normal and you do not need to worry about it. You may also have numbness at your incision site and in the surrounding area. This is also normal and will improve with time.
When is my first appointment after surgery?
Your first appointment after surgery will be 7 to 10 days after your surgery. Your nurse will give you instructions on how to make this appointment, including the phone number to call.
Your surgeon will check your incision. Your pathology report should be ready and your surgeon will discuss it with you. You will also talk about whether you need more treatment.
Will I need more treatment?
Many people will not need more treatment. However, if you have papillary thyroid cancer, you might need radioactive iodine therapy. Your healthcare team will talk with you to decide if this is the best treatment for you. Your team will include your surgeon, an endocrinologist, and a doctor from nuclear medicine. If you need radioactive iodine, your endocrinologist will talk to you about how the treatment is given.
Will I need special blood tests after my surgery?
You will have thyroid function tests beginning 6 to 8 weeks after your surgery. There are 2 tests: thyroid stimulating hormone (TSH) and free thyroxine (FT4). These tests will show whether you have the right amount of thyroid hormone in your blood. Your doctor or nurse practitioner will use the results of these tests to adjust the amount of thyroid medication you take.
If you had your entire thyroid removed for papillary cancer, you will need to have a blood test called thyroglobulin 6 weeks after your surgery. You will have this blood test every year so that your doctor can look out for patterns in your results.
If you have medullary thyroid cancer, you will need to have blood tests called carcinoembryonic antigen (CEA) and calcitonin 6 weeks after your surgery. You will have these blood tests every year so that your doctor can look out for patterns in your results.
What if I have other questions?
If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm. Call the office directly at ______________.
After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the doctor on call for your doctor.
- You have a temperature of 100.4° F (38° C) or higher
- You have drainage from your incision
- You have shortness of breath
- You have warmer than normal skin around your incision
- You have increased discomfort in the area around your incision
- You have increased redness around your incision
- You have new or increased swelling around your incision
- You have numbness, twitching, or tingling around your mouth, fingertips, or toes