Before and after surgery for thyroid cancer

Surgery is usually the main treatment for:

• papillary and follicular thyroid cancer
• medullary thyroid cancer (MTC).

Surgery is only suitable for a small number of people with anaplastic thyroid cancer. Your doctors may recommend it if the cancer has not grown outside the thyroid gland.

After your operation, the nurses on the ward will help you to lie in an upright position, supported by pillows. This helps to reduce swelling in your neck area. They will regularly check your:

• blood pressure
• pulse
• oxygen levels.

After surgery you will have a blood sample taken. This is to check your calcium levels.

Sometimes surgery to the thyroid might damage the parathyroid glands. These glands help to control calcium levels. The damage might be temporary, but in some people it can be permanent. Your doctor will prescribe calcium tablets and a form of vitamin D for you to take.

Operations to the neck area may cause swelling. This can make eating and drinking difficult and uncomfortable for a time.

You will usually have a tube going into a vein in the arm. This is called an intravenous drip. The nurses give you fluids through this tube for a few days. It is removed when you can drink fluids again.

You may have 1 or 2 thin plastic drainage tubes coming from the operation area. The tubes collect fluid from the wound. Drains usually stay in place for 2 to 7 days.

If you go home with a drain, the district nurse can check it. You usually come back to hospital to have it removed.

The nurses will check your wound regularly for signs of any problems with:

• bleeding
• infection.

Bleeding inside the wound might cause a collection of blood to form. This is called a haematoma. It causes the neck to swell.

If you do not have dissolvable stitches, you usually have your stitches or staples removed about 7 days after surgery. Some wounds are sealed closed using a glue.

The nurses will give you advice on what to do when you go home and how to recognise any signs of infection. Contact the hospital straight away if there are signs of infection. These can include the following:

• If you have white skin, the skin around the wound may appear redder.
• If you have black or brown skin, the skin around the wound may appear darker.
• Any swelling or heat around the wound.
• Any discharge from the wound.

District nurses can visit you at home and check your wound.

You will probably have some pain or discomfort after your operation. Your doctor will give you painkillers to help. If you are still sore, tell your nurse so that they can change the type of painkillers you get.

The skin on your neck up to your jawline might feel numb after surgery. This is caused by the local anaesthetic used during surgery.

You should be able to start drinking an hour or so after your operation. You may find it painful to swallow solid foods at first. You may need to start by eating soft foods.

Over the next 2 to 3 days, you should find it easier to swallow and can start eating solid foods. The nurses or a dietitian will discuss this with you before you go home.

It is important to have a balanced diet. If you are finding it difficult to eat, nutritious drinks are a good way to supplement your diet.

How long you are in hospital will depend on the operation you had and your recovery. You might be ready to go home about 1 to 2 days after your operation. Recovery takes time and it is faster for some people than others.

Eat healthily and try to pace yourself. Avoid doing too much too soon. You can slowly build up your strength and fitness with light exercise, such as short walks.

Follow the advice your cancer team give you, for example:

• Do not lift heavy items for a minimum of 4 weeks, to avoid any strain on your neck wound.
• Avoid putting your wound completely under water until at least 2 weeks after surgery, or until your surgeon says it is okay
• Do the neck exercises you have been shown and carry on with these for 3 months even if you already have full movement and strength back. Take painkillers about 30 minutes before you do them. You might be advised to keep on doing these exercises.
• Avoid direct sunlight to your wound and when the wound is healed always use a high sun protection factor (SPF) to protect the skin.

You can do some light physical activity, such as walking. You can gradually build up your activities and do them for longer. To protect your neck and wound you will need to avoid contact sports for a while. Your cancer team can tell you more about this.

Everyone recovers from surgery differently. Most people can return to work within a few weeks of your operation, but this will depend on the type of work you do. You might need more time if your work involves:

• heavy lifting
• standing for long periods
• walking around a lot.

Your doctor will tell you when it is safe for you to start driving after your surgery. You must be able to do an emergency stop and be able to turn your neck in all directions. Make sure you do not have any side effects from the painkillers, such as feeling drowsy.

You may need to tell your insurance company that you have had thyroid surgery. Some policies give time limits for not driving after surgery.