Something you should know before thyroid surgery

[Lao Xu, I had thyroid surgery, but my voice was dumb. What should I do? As soon as I finished speaking, my friend Miss Ye began to cry.

Half a month ago, Miss Ye had a total thyroidectomy for thyroid [papillary cancer]. Listening from the phone, her voice really became hoarse and deep. After examination, this is a complication caused by Miss Ye’s thyroid surgery. Miss Ye was blindsided and at a loss. No matter what’s surgery, it is not a trivial matter. Before thyroid knife, you should know something.

Do you need thyroidectomy?

Under normal circumstances, three types of patients need thyroid surgery.

The first category is patients with thyroid nodules.

However, not all people with thyroid nodules need surgery, and surgery will only be recommended if one of the following conditions occurs.

    Definitely malignant nodule; Highly suspected malignant nodule; Nodules grow up rapidly, or affect the appearance; Nodules have compression symptoms on trachea or esophagus, such as dyspnea and dysphagia. Accompanied by hyperthyroidism, oral drug therapy is ineffective; The thyroid gland, which was supposed to stay in the neck, was born behind the sternum. Unfortunately, the thyroid gland also grew nodules.

The second category is hyperthyroidism (hyperthyroidism for short) patients.

If one of the following conditions is met, surgery can be considered to treat hyperthyroidism.

    Hyperthyroidism caused by excessive thyroxine secretion by thyroid nodules; Hyperthyroidism with obvious enlargement of thyroid gland, or swollen thyroid gland compresses trachea and esophagus; Thyroid gland is behind sternum and swollen hyperthyroidism occurs. Recurrence after oral drug or radioiodine treatment, or difficulty in insisting on long-term medication; Hyperthyroidism causes heart failure, arrhythmia and other heart diseases; Complicated or suspected to be complicated with thyroid cancer.

The third category is patients with thyroiditis.

    Such as acute thyroiditis accompanied by abscess formation; Hashimoto’s thyroiditis with goiter affects the appearance or compresses trachea and esophagus. Suspected thyroid cancer, etc.

These conditions are suitable for surgical treatment.

How to cut, the disease has the final say.

Thyroid surgery is an operation to remove goiter or thyroid gland itself, but how to cut it is still up to the patient’s condition.

1. Resection of nodules and surrounding normal thyroid tissues only

This kind of situation is mostly aimed at a single thyroid nodule, and the nodule is benign.

2. Resection of one side of thyroid tissue

The thyroid gland is divided into left and right lobes. When a single nodule cannot distinguish benign from malignant or the malignant nodule is papillary thyroid carcinoma with low risk of recurrence and metastasis, and the nodule size is less than 1 cm, only the diseased thyroid gland can be considered to be cut off.

3. Resection of more than half of thyroid tissue

If there are many thyroid nodules, both the left and right lobes are benign, and the resection range is more than half of the thyroid gland.

These three surgical methods can enable patients to retain nearly all or a small amount of thyroid tissue and maintain certain thyroid function, but these three surgical methods also make nodules have the probability of recurrence. Once recurrence occurs, it is very difficult to operate again, and none of them are the main surgical methods.

Moreover, for hyperthyroidism and Hashimoto’s thyroiditis, if the above-mentioned method is adopted to remove thyroid tissue, more thyroid tissue will be retained, leaving a curse for the recurrence of the disease.

4. Retain no more than 10% of thyroid tissue on one side, and remove all the rest, even remove all thyroids on both sides.

This surgical method is currently the main surgical method, which is suitable for people with more benign or malignant nodules of bilateral thyroid gland, as well as patients with hyperthyroidism and thyroiditis.

5. Resection of all thyroid and cervical lymph nodes

If malignant nodules are accompanied by cervical lymph node metastasis, the cervical lymph nodes should be removed.

These procedures can be performed with the help of a tool called endoscopy, which makes a small hole in the front of the neck or beside the areola of the armpit or nipple. There is no obvious scar after the operation, and the skin is still beautiful. Only severe thyroid cancer cannot be operated by endoscopy.

There are complications in the operation, but there is no need to fear.

All operations have complications, and thyroid surgery is no exception, but there is no need to fear or even refuse thyroid surgery, because the incidence of most complications is very low.

    Recurrent laryngeal nerve injury, superior laryngeal nerve injury, hypocalcemia, hypothyroidism, hemorrhage and infection, trachea softening and collapse

Regular review, don’t be careless

After thyroid surgery, usually stay in hospital for 3-5 days, use antibiotics, observe wound and vocalization, and check thyroid function, blood calcium, blood phosphorus and other indicators.

How to recheck after discharge?

  1. Blood calcium and blood phosphorus: temporary hypocalcemia is examined once a week, and they will gradually return to normal after 2-4 weeks. Permanently hypocalcemia is examined once a month, if it is normal for 3 consecutive months, it can be examined once a month instead. If numbness and convulsion of hands, feet, mouth and face are aggravated, please seek medical treatment as soon as possible.

  2. Thyroid function: Hypothyroidism is examined once a month. If it is normal for 3 consecutive months, it can be examined once every 3 months. It is still normal and can be examined once every six months. If fear of cold and fatigue is aggravated and obvious edema occurs, it indicates that hypothyroidism is aggravating, please seek medical treatment as soon as possible.

  3. Thyroid color Doppler ultrasound: thyroid cancer should be examined once every 3-6 months within 1 year after operation, and once every 6-12 months after no abnormality. Hyperthyroidism, Hashimoto’s thyroiditis and benign thyroid nodules are examined every 6 ~ 12 months.

  4. Thyroglobulin: It is the only protein synthesized and secreted by thyroid gland in human body. When thyroid cancer has residue or recurrence, thyroglobulin can be detected to continuously increase. Therefore, thyroglobulin is detected every 6 ~ 12 months after thyroid cancer surgery.

How to eat after operation? How long can I start exercising?

First, eat

Day 1 after operation: On the day after thyroid surgery, you should eat warm and cool liquid diet, such as broth, fruit juice and rice soup.

2 ~ 3 days after operation: still give warm and cool semi-liquid diet such as porridge and noodles to avoid irritation to the wound.

Three days after the operation: it can be gradually changed to soft food and common diet, with high calcium and vitamin-rich foods as the main food to avoid spicy and irritating foods.

Patients who turn to hypothyroidism after operation should pay attention to low-fat diet. It turns out that patients with hyperthyroidism do not need to eat iodine-forbidden diet, and it is possible to eat iodized salt and seafood in an appropriate amount.

2. Motion

Do not exercise or lift heavy objects within 2 weeks after the operation. Mild exercises such as fast walking and cycling can be carried out after 2 weeks. Normal exercises can be carried out after 1 month of the operation.