About Your Thyroid Surgery

About Your Surgery

The thyroid gland is a small, butterfly shaped gland in the lower part of the front of your neck. It produces hormones that control the way your body turns oxygen and calories into energy.

Lymph nodes are small oval or round structures found throughout the body. They make and store cells that fight infection.

The parathyroid glands lie behind the 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. 

Removal of Your Thyroid Gland

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 the gland is removed, it is called a lobectomy or hemi-thyroidectomy.
  • If the entire gland is removed, it is called a total thyroidectomy.

Your surgery will take 2 to 3 hours. You will stay in the hospital overnight after your surgery. Most patients are discharged in the morning. 

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Before Your Surgery

Preparing for Your Surgery

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.

About Smoking

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.

Within 30 Days of Your Surgery

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)

Health Care Proxy

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. The person you identify is called 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 advance directive, bring it with you to your next appointment.

10 Days Before Your Surgery

Review Your 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).

Make Travel Arrangements

If you will go home the day after your surgery, someone who is at least 18 years old must come to the hospital to take you home. If you don’t have anyone, call one of the agencies below to help.

In New York:

     Partners in Care 888-735-8913

     Prime Care 212-944-0244

In New Jersey:

     Caring People 877-227-4649

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.

Purchase Supplies

You will need to have the following medications when you the hospital:

  • Tums Ultra® (for calcium supplement)
  • ___________________________________________________________________
  • ___________________________________________________________________

7 Days Before Your Surgery

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.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.

2 Days Before Your Surgery

Review Your 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).

1 Day Before Your Surgery

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 at the hospital for your surgery. If you are scheduled for surgery on Monday you will be called on the Friday before.

The Admitting clerk will tell you where to go on the day of your surgery. This will be either the Surgical Day Hospital (SDH) or the Presurgical Center (PSC). If you do not receive a call by 7:00 pm, please call 212-639-5014. 

Both locations are at 1275 York Avenue between East 67th and East 68th streets.

  • Surgical Day Hospital (SDH). M elevator to the 2nd Floor
  • Presurgical Center (PSC). B elevator to the 6th Floor

Sleep

Go to bed early and get a full night’s sleep.

Morning of Your Surgery

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.

  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
  • Sneakers that lace up. You may have some swelling in your feet; lace-up sneakers can accommodate this swelling.
  • Only the money you may need for a newspaper, bus, taxi, or parking.
  • A CD player and CDs or an iPod, if you choose, however someone will need to hold it for you when you go into surgery.
  • Your incentive spirometer, 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.

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and birth date many times. This is for your safety. Patients with the same or similar names may be having surgery on the same day.

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. 

Get Dressed for Your Surgery

You will be given a hospital gown, robe, and non skid socks.

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After Your Surgery

What to Expect

In the Recovery Room

When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU). Once your anesthesia has worn off, you will be taken to your hospital room. There, your nurse will tell you what you can do 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 instructions on how to use your incentive spirometer, please read How to Use Your Incentive Spirometer.  

Commonly Asked Questions

Here are some commonly asked questions patients ask after surgery. Ask your doctor or nurse to explain anything you don’t understand or if you have additional questions.

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 acetominophen (Extra Strength Tylenol) instead. Ask your nurse or doctor when to take other over-the-counter pain medication. 

What can I 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.

When 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.

How do I care for my incision?

While you are in the hospital, 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 the hospital. In most cases, your staples or stitches will be removed during your first appointment with your doctor after your surgery.

What medications will I need to take?

If your entire thyroid gland was removed, you will need to replace the hormone it produces. There are many thyroid hormone drugs; whichever one you take, you must take it every day for the rest of your life. Your doctor will prescribe it for you and tell you how much to take. You will likely need blood tests every so often. This is to make sure you are getting enough, but not too much of the drug. 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. For more information about used after thyroid surgery, please read Levothyroxine.

When can I resume my normal activities?

You can resume most activities right after your surgery. Here are some things you should not do:

  • Do not drive for at least 1 week after your surgery. Once you feel comfortable turning your neck to look for traffic, you can resume driving.
  • Do not lift objects heavier than 10 pounds for at least 2 weeks after your surgery

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.
  • Do not use weights or machines on your upper body. Limit all upper body exercises, but you can do lower body exercises.

Avoid having the sun on your incision site for a year after your surgery. 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 two.

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.

  • 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

When should I see my surgeon?

You should see your surgeon 7 to 10 days after your surgery. Call the office to make the appointment. 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 patients 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 two 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 (called a total thyroidectomy) 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.

Survivorship

What kind of follow-up care will I receive?

After your initial treatment for thyroid cancer, you will continue to see your surgeon, endocrinologist, and/or nuclear medicine specialist. Over time, you will probably need to see only one of these specialists. You and your doctor will decide when that time is right for you.

Once your initial treatments are completed, you may be eligible to join the Thyroid Cancer Survivorship Program. Your doctor will help you decide when you are ready for this step. The program will help support you as you recover from the physical and emotional effects of thyroid cancer. The Thyroid Cancer Survivorship Program is located in the Endocrine Clinic at MSK. A nurse practitioner, who will work closely with your doctor, will be responsible for your care. The nurse practitioner is a member of the thyroid cancer team at MSK and an expert in the care of cancer survivors. He or she will:

  • Look for signs of the cancer returning
  • Manage any effects of treatment, such as pain and fatigue
  • Recommend screening tests for other cancers
  • Provide counseling about living a healthy lifestyle, such as diet, exercise, and quitting smoking

During visits with your nurse practitioner, he or she will:

  • Talk with you about your medical history
  • Perform a physical exam
  • Order tests, such as x-rays, scans, and blood tests
  • Make referrals to other healthcare providers, if needed
  • Prescribe medication, if needed

If you would like more information about our Survivorship Program, talk with your doctor or nurse.

When can I transition my follow-up care outside of MSK? 

As your needs decrease, your follow-up care may be transferred from MSK to an endocrinologist in your community. We will assist you in finding an endocrinologist if you don’t already have one.

The timing of this depends on your particular thyroid cancer and your response to treatment. It often occurs about 2 to 5 years after treatment. Your MSK doctor or nurse practitioner will send your local doctor a detailed summary of your care at MSK and copies of your test results. This report will also include our recommendations for future management based on the thyroid cancer treatment you received.

Your MSK doctor and nurse practitioner are available to you and your local doctor if there are any questions about your care, or if you develop a new thyroid cancer problem.

 

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MSK Support Services

The following are MSK resources that you may find helpful.
 
Admitting
212-639-5014
Call the Admitting office to discuss private room or luxury suite options. If you want to change your room choice after your Presurgical Testing visit, call 212-639-7873 or 7874. 
 
Anesthesia
212-639-6840
Call with questions about anesthesia, the medications used to make you sleepy for your surgery. 
 
Blood Donor Room
212-639-7643
If you are interested in donating blood or platelets, call for more information. 
 
Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you are an international patient, call the International Center for help coordinating your care.
 
Chaplaincy Service
212-639-5982
Spiritual and religious resources provide comfort and strength for many patients. The chaplains at MSK are available to help you access those resources. They can provide spiritual support for anyone. If you have a specific religious need, please call the number above. The interfaith chapel is located near the main lobby of 1275 York Avenue. It is open 24 hours a day. If there is an emergency, please call the hospital operator and ask for the chaplain on call. 
 
Counseling Services
646-888-0100
Many people find counseling helpful. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. 
 
Integrative Medicine Service
646-888-0800 (outpatient)
646-888-0888 (inpatient)
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. 
 
Patient-to-Patient Support Program
212-639-5007
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers. 
 
Patient Financial Services
212-639-8242
Call Patient Financial Services with any questions regarding preauthorization with your insurance company. This is also called preapproval. Patient Financial Services can also help you with your billing or other insurance questions.
 
646-497-9176
Call the number above for general information about your insurance coverage. Remember, you must call your insurance company for preauthorization.
 
Patient Representatives
212-639-7202
Call the Patient Representatives office if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.
 
Perioperative Clinical Nurse Specialist
212-639-5935
If you have any questions about MSK releasing any information while you are having surgery, call the clinical nurse specialist.
 
Private Nursing Options
212-639-6892
Patients may request private nurses or companions. For more information, call the Private Duty Nursing Office.
 
Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
 
Social Work
212-639-7020 
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide counseling on getting used to a serious illness, advice on how to communicate with family, friends, and young children, and help with employment issues.
 
Tobacco Cessation Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.
 
The following are resources outside of MSK that you may find helpful:
 
American Cancer Society
 
National Cancer Institute
 
Light of Life Foundation
 
Thyroid Cancer Survivors’ Association
 
For additional web based information visit LIBGUIDES on MSK’s library website at http://library.mskcc.org or the Thyroid Cancer section of MSKCC.org. You can also contact the library reference staff at 212-639-7439 for assistance.

Additional Resources

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If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.
About Your Thyroid Surgery
©2015 Memorial Sloan Kettering Cancer Center - Generated on July 2, 2015