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Thyroid Surgery

Experience and Excellence in Thyroid Surgery

Dr. John Abikhaled stays up-to-date on the latest thyroid surgery techniques, offering patients a range of minimally invasive procedures that can help you recover faster and resume your normal life. His extensive experience allows him to identify unique patient needs and create a surgical plan that is not only effective, but also customized to your unique situation.

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Common Questions about the Thyroid Gland

What does the Thyroid do?

The thyroid is a butterfly-shaped gland in your lower neck.  It has two lobes connected by a narrow strip called the isthmus. The thyroid makes hormones that control your metabolism. Sometimes the thyroid makes too much or too little hormone, causing health problems.

What is Hypothyroidism?

When the thyroid doesn’t make enough hormone, it is called hypothyroidism. This can make you feel sluggish, cold, weak, and depressed. It can also constipation, weight gain, muscle soreness, and in women it can cause heavy or irregular menstrual periods.

What is Hyperthyroidism?

When the thyroid makes too much hormone, it is called hyperthyroidism. This can make you feel nervous, irritable, hot, and tired. It can also cause rapid heart rate, muscle weakness, weight loss, more frequent bowel movements, hand tremor, and in women it can cause irregular menstrual periods. 

How is a Thyroid Nodule different from a Goiter?

  • Thyroid nodules are lumps within the thyroid gland. Most thyroid nodules are harmless, but some nodules can cause problems or be dangerous. Thyroid nodules can be overactive (causing hyperthyroidism), malignant (cancerous), large enough to be felt or seen in the neck, or large enough to cause discomfort or compression in the neck, with trouble swallowing, breathing, or speaking.
     

  • A goiter is an enlargement of the whole thyroid gland. This can happen from the growth of multiple nodules or from enlargement of the entire gland, such as in Graves’ Disease, an autoimmune condition. 

Thyroid Gland Evaluation

How is the thyroid function assessed? 

Evaluation of the thyroid starts with an examination of the neck and palpating (feeling) the gland directly to detect nodules or enlargement of the gland. Blood tests are done to measure thyroid function. If appropriate, further testing can include ultrasound, which uses sound waves to look at the structure of your thyroid gland. This test can show if you have nodules. The ultrasound can measure the size and shape of the nodules and look for signs that raise suspicion for cancer. A nuclear thyroid scan uses an iodine tracer to see how your thyroid is working. This test can show if areas of your thyroid gland are over-active or under-active.

 

Fine Needle Aspiration Biopsy (FNA biopsy) is a way to sample thyroid nodules for possible cancer. This test uses a thin needle to take some cells from a nodule. The cells are examined in the lab and can help determine if nodules are benign (not cancerous) or malignant (cancerous). An FNA biopsy is done in the office using ultrasound to guide the needle into the nodule. A local anesthetic is used to numb up the skin, and the procedure takes just a few minutes. The results of the FNA biopsy will help determine if further treatment is needed, such as surgery, or if the nodules can simply be monitored. Sometimes, results can be inconclusive, and it may be necessary to repeat the biopsy.

Thyroid Treatment

Hypothyroidism

Hypothyroidism is treated by thyroid hormone replacement. This is managed by your primary care physician or your endocrinologist. 

Hyperthyroidism

Hyperthyroidism can be treated with medications, by ablation with radioactive iodine, or with surgery to remove the thyroid. Your endocrinologist and your surgeon will help you determine which option is best for you. 

Nodules or Goiter

If you have small, stable, and symptom-free nodules in your thyroid, you may not need any treatment except regular check-ups with your endocrinologist (a hormone specialist), or your primary care physician. Re-evaluating the nodules with ultrasound periodically may be recommended.
 

If you have a suspicious or cancerous nodule, or a goiter, you may need surgery to remove all or part of your thyroid. This is called a thyroidectomy. If you have thyroid cancer, you may also need treatment with radioactive iodine after surgery, which is a medicine that eliminates remaining cancer cells.

Thyroid Surgery

In thyroid surgery, Dr. Abikhaled removes part or all of your thyroid gland. In a thyroid lobectomy, only one side of your thyroid gland is removed. A total thyroidectomy includes removal of the whole gland. 

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Surgery is performed in the operating room under anesthesia, through a small incision along the lower neck. Depending on the extent of surgery, you may be able to return home the same day, or you may stay overnight.

 

When a cancer diagnosis can’t be made prior to surgery, Dr. Abikhaled will remove the lump with a lobectomy and send it to a lab for testing. If the lump turns out to be cancerous, you may need another surgery to remove the rest of your thyroid gland. This is called a completion thyroidectomy.

 

Sometimes we may also need to remove lymph nodes near your thyroid gland if they have cancer cells in them.

Nerve Monitoring

One of the risks of parathyroid surgery is injury to the nerves that make the vocal cords move.  This can result in hoarseness or a weak voice.  We use nerve monitoring to minimize this risk.  Sensors on the breathing tube used for anesthesia are in contact with the vocal cords. If a nerve is stimulated during surgery, the vocal cord is activated, and the sensor produces an audible signal. This helps protect the nerves from injury.

Recovery from Thyroid Surgery

Recovery from parathyroid surgery is usually not very difficult.  Here are the most important things to know about your recovery:

 

  • When you get home from the hospital, you will want to rest for a while, but then it is important to get up and around, and to walk.  You should also walk the day following surgery and gradually increase your activity as tolerated. There is no reason to stay in bed.  You should take it easy however, and not engage in very strenuous activity for 2 weeks.
     

  • Your incision will be sealed with skin glue, which will peel off after a couple weeks. The sutures are buried under the skin and will dissolve. There will be no bandage to change.

 

  • You may eat & drink whatever is comfortable for you after surgery. Cool liquids, throat lozenges and voice rest can be helpful as needed.
     

  • You may shower beginning the day after surgery. You should not immerse the incision under water for 2 weeks.  After 2 weeks you can swim, etc.

 

  • You may have a sore throat and mild temporary hoarseness after surgery.
     

  • You should apply ice packs to your incision for 20 or 30 minutes at a time, several times the day of surgery and for 2 days after surgery. This keeps the swelling and soreness down.
     

  • You may only need over the counter pain meds like Tylenol (acetaminophen) and Advil (ibuprofen). You can take two regular strength Tylenols (325 mg each) and two Advils (200 mg each) together about every 8 hours.  
     

  • A prescription pain medication is usually also prescribed, but most people need little or none.

Low Calcium Levels after Surgery

Some patients experience temporary low calcium levels after a total thyroidectomy due to manipulation of the delicate parathyroid glands.
 
 

  • Symptoms of low calcium include a numb or tingling feeling around your lips, on your face, or in your hands or feet.  Symptoms can also include muscle cramps or spasms, especially in the hands or feet, or twitches in the muscles of your face.
     

  • This low calcium level is easily treated by taking a calcium supplement such as Citracal Maximum Plus. This supplement contains calcium citrate and vitamin D, which helps your body absorb the calcium.  Please have a bottle handy after surgery. If you develop symptoms, you should take 2 tablets. The symptoms will resolve after 20-30 minutes. You will need to continue taking the supplement about 3-4 times a day until the normal parathyroid glands “wake up.” Please call the office and let us know if you develop symptoms of low calcium.

Thyroid Hormone Replacement after Thyroidectomy

Thyroid hormone replacement may be started or adjusted after thyroidectomy.  A blood test to check your thyroid hormone level will be done a few weeks after surgery. This is typically ordered by your endocrinologist.

 

  • If you were on thyroid hormone replacement prior to surgery, you will continue to require replacement after surgery. It may be necessary to adjust the dose, depending on blood test results.

  • If you were not on thyroid hormone replacement prior to surgery and you have a total thyroidectomy, thyroid hormone replacement will be started after surgery.

  •  If you were not on thyroid hormone replacement prior to surgery and you have a thyroid lobectomy (removal of only half of the thyroid), it is possible you may require thyroid hormone replacement if the remaining half of your thyroid gland does not produce enough hormone.

Follow-up After Surgery

  • We'll want to follow-up about 2 weeks after surgery. Please call to make an appointment. 
     

  • The thyroid gland is sent to the lab for analysis.  Dr. Abikhaled will have that result for you at your post-op visit. 

 

  • You will also continue to have ongoing visits with your endocrinologist after surgery. Please call their office after surgery to make an appointment with them.

Risks of Thyroid Surgery

  • Any surgery has risks, and there can be complications. Fortunately, complications are quite uncommon. Risks include, but are not limited to:

  • Bleeding

  • Infection

  • Complications related to anesthesia

  • Injury to the recurrent laryngeal nerves which can cause vocal cord malfunction and hoarseness

  • Injury to the external branch of the superior laryngeal nerves which can cause voice changes

  • Other very rare complications including injury to other nerves or structures (such as vagus nerves, sympathetic nerves, trachea, larynx, esophagus, carotid artery, jugular vein), or death.
     

 

You should call the office if you experience increasing swelling at the incision site (some swelling is expected), severe pain, bleeding, signs of infection, a temperature over 100.4 degrees Fahrenheit. You should also call if you develop symptoms of low calcium that do not respond to taking Tums. Symptoms of low calcium include numbness or tingling around the lips or in the extremities, or muscle cramps.

THYROID SURGERY
TESTIMONIALS

Dr. Abikhaled did my thyroidectomy 2 weeks ago. My incision site is beautiful! He did an amazing job. I know people who are 8-12 months post op who's incisions dont look as good as mine does just 2 weeks post op.
 
I was also very impressed with my initial consult with him, prior to my surgery. He took the time to draw out a diagram and explain and great deal the procedure and associated risks involved.
 
After fighting hyperthyroidism and graves for the past 18 months, I am so happy to say that I feel great finally!!

- Nichole L.

SAY HELLO TO
DR. ABIKHALED

Dr. John Abikhaled is a highly skilled surgeon based in Austin, Texas, who specializes in thyroid surgery. He is dedicated to providing his patients with the most advanced and minimally invasive techniques available, which can help you recover faster and return to your daily routine sooner.

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