From a nodule to hyperthyroidism, there are several reasons that may require surgery for partial or total thyroid removal. The most important consequence for the patient who has undergone the operation will be adherence to lifelong hormone replacement therapy to ensure the delivery of thyroid hormones. Physical activity and diet indications will be more stringent in the first period after surgery. We talk about this topic with Professor Andrea Lania, Professor of Endocrinology at Humanitas University and Head of the Operating Unit of Endocrinology at Humanitas.
If partial synthetic hormones are not necessary
The thyroid gland is an endocrine gland that produces hormones that are fundamental to different aspects of metabolism. These substances, circulating in the blood, reach the tissues and contribute, for example, to regulate body temperature, energy balance and heart rhythm.
The formation of cysts or one or more large thyroid nodules, the onset of a thyroid tumor as well as the development of the goiter, i.e. the benign increase in the size of the gland, or hyperthyroidism frameworks not responding to medical therapy are all reasons that may require a thyroidectomy.
If the thyroidectomy is partial, with the removal of one of the two lobes of the gland or part of a lobe, thyroid function is generally not impaired. If the thyroidectomy is total, the body will not be able to produce thyroid hormone for the different functions of the body and therefore it will be necessary to adhere to lifelong hormonal replacement therapy, with the intake of synthetic thyroid hormone. The dosage will be determined in the light of blood tests and over the years it may also be reviewed in consideration of particular conditions such as pregnancy.
Even when only one lobe has been removed, hormonal replacement therapy may be needed over the years because hypothyroidism may develop, especially in patients with thyroid autoimmunity. It is therefore necessary to always monitor the patient’s health condition. In any case, hormonal therapy is necessary to avoid the onset of fatigue, difficulty in concentrating, weight gain, dry skin, hair loss, cold hands and feet, constipation and muscle cramps.
With the removal of the thyroid gland or part of it, one or more parathyroids, the small glands placed behind the thyroid gland involved in regulating circulating calcium levels, may also be accidentally removed or damaged. In these cases, supplementation with calcium salts and vitamin D is necessary.
After the operation, the patient will take painkillers and may be contraindicated to drive as the medication may induce drowsiness. Thyroidectomy surgery leaves a horizontal scar at the base of the neck. During the first six months of operation, it will be essential to avoid exposure to the sun.
In the early stages after surgery, a period of reduction in physical activity may be necessary, but a light intensity period is encouraged for as long as possible. For the diet it might be useful to eat more liquid foods in the first few days; the patient may also feel a feeling of annoyance to swallowing. Moreover, in the first few days hoarseness may arise, which will tend to regress spontaneously in a few months. Subsequently, the diet to be followed will have to be a normal, balanced diet. Beware of excessive soybean consumption, which could interfere with the absorption capacity of medications in hormone replacement therapy.