3555 South Culpepper Circle
Springfield, Missouri 65804
(417) 887- 3855 / www.springfieldent.com
We wish your surgical experience to be as positive and free of stress as possible. Please contact our office if you have any concerns - remember, there are no silly questions!
Please, do not take any "blood thinning" medications such as aspirin, ibuprofen, Motrin, Advil,
Aleve, Naprosyn, naproxen, etc. for two weeks before surgery and one week afterward because this may increase your risk of bleeding. Acetaminophen (Tylenol) is OK; check with our office before taking any other cold, allergy, or other-over the-counter medications.
The thyroid gland
This small gland produces thyroid hormone, which controls metabolism. It is located in front of the trachea (windpipe) and larynx (voice box). Several important structures are located near the thyroid gland. The parathyroid glands control the blood calcium level and sit behind the thyroid. The two nerves
(SLN and RLN) to the vocal cords are located above / below and
Larynx
SLN
Thyroid behind the thyroid gland on each side. These glands / nerves are the main structures at risk during thyroid surgery.
Common reasons for surgery
RLN
Trachea
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Removal of a growth or nodule on the thyroid gland because it is or may be cancerous
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Removal of an enlarged thyroid gland because it is compressing nearby structures or causing cosmetic, voice, swallowing, or other problems
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Removal of part or all of the thyroid gland because of hyperthyroidism (too much thyroid hormone) that has not responded to other treatment
Alternatives to surgery
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Observing the condition to see if a thyroid nodule enlarges or becomes more concerning for cancer.
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Studying the gland with periodic scans or biopsies
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Medication or radioactive iodine therapy for an overactive thyroid gland
Scheduling surgery
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Surgery will have been discussed and recommended during a regular office visit. Sometimes our pre - surgical paperwork shall be done at that same appointment
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Removal of part of the thyroid can be done as outpatient surgery. Total thyroidectomy usually involves staying overnight or perhaps several days to monitor your calcium level o Our surgery scheduler will discuss the specific plans for you o Surgery is done at Cox Surgery Center or Cox South Hospital o You will need to call Cox to pre - register and also call the surgery preadmission department to have your preoperative telephone anesthesia interview (two separate telephone calls) o In some cases, the anesthesiologist will need you to come in for an actual preoperative visit with them o Laboratory testing and x-rays are not normally needed but this is usually decided by the anesthesiologist

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Postoperative visit / recheck for removal of sutures about 1 week after surgery
What to expect with surgery
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Incision - The incision is placed in the front of the lower neck, about 1-2 inches above the breastbone. It runs horizontally (side to side) in the direction of normal skin creases (to help make it less visible) and is about 4 inches in length
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Anesthesia - Performed under general anesthesia (patient asleep)
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Hospital stay - Removal of the whole gland usually involves an inpatient stay to check the blood calcium level while removal of half the thyroid can be done as outpatient surgery.
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Drain If needed, a small drainage tube is placed to drain any blood or and is removed in a day or two
What to expect after surgery
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Pain Generally well controlled with pain medication. Swallowing and head turning may be uncomfortable
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Swelling and bruising Normal after surgery. Elevating the head and neck reduces this
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Activity - No driving for about 1 week since it is uncomfortable to turn your head after surgery.
Do not drive while taking narcotic pain medication. Avoid heavy lifting for 2-3 weeks
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Work - Plan on being at home about 1week, depending on your type of work.
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Diet - Sometimes need to avoid iodine / shellfish in case you will have an iodine scan or radioactive iodine treatment after surgery
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Incision care - Keep incision dry 24 hours after surgery and removal of the drain. Apply antibiotic ointment 4 times daily to incision for 10 days. Clean crusting with Q - tip and peroxide
Risks and complications
Although thyroidectomy is relatively safe surgery, all operative procedures involve a certain amount of risk such as infection, bleeding, anesthesia reactions, or even death. Complications are unusual but a partial list of these include:
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Anesthesia - Adverse reaction to anesthetic agents or other medications
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Bleeding A small amount is normal after surgery and a drain tube may be brought out through the skin to collect blood and fluid. On rare occasions, a blood or fluid collection may require removal in the operating room
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Infection Suggested by fever, redness, increasing pain, or pus-like discharge.
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Nerve injury - To the recurrent laryngeal nerves (RLN) or superior laryngeal nerves (SLN) which could cause temporary or permanent voice change or hoarseness. See illustration above
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Parathyroid glands - Injury to these glands could cause temporary or permanent decreased levels of calcium requiring treatment with calcium and / or medicine
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Scarring - Unfavorable healing of incisions may occur
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Neck structures - There are many important blood vessels, nerves, voice / airway, swallowing, and other structures all located in the neck. Although unlikely, there is the risk of injury to these structures and even to structures in the chest
Thank you again for the opportunity to participate in your health care! Please let us know if we can answer any further questions or how we may make your surgical experience more pleasant!