Endocrine Surgery

Division of Surgical Oncology
Endocrine Surgery


Before and After Thyroid Surgery

Before Surgery

Before Your Clinic Visit:
Prior to your clinic visit, you may need to undergo some testing to evaluate your thyroid. Testing may include ultrasound and/or fine needle aspiration biopsy (FNA), as well as routine blood work.

Before Surgery:
Prior to having surgery, a series of general screening tests may be done to make sure you are healthy for surgery. These are often conducted 1-2 weeks before the operation and may include a thorough history and physical exam and blood work. Depending on your history, you may also need an EKG, chest x-ray, and/or stress test. These tests evaluate your heart and lung function and usually do not require a hospital stay. Depending on your age and health, you may need to see your primary care doctor or a high-risk anesthesiologist for these tests.

Prior to surgery, you may also meet with an endocrine surgery nurse practitioner who will educate you about the operation and make sure all the appropriate testing has been completed.

MEDICATION GUIDELINES

PLEASE ASK your doctor or surgeon BEFORE stopping or changing any of your medications.

Medication Guidelines Prior to Surgery:
Certain medications may need to be stopped before surgery. Please consult your surgeon or primary care physician before stopping any of your prescribed medications.

Cardiac medications (blood pressure medications): DO NOT take on the day of surgery:

   Benazepril (Lotensin)
   Bumetanide (Bumex)
   Candesartan (Atacand)
   Captopril (Capoten)
   Enalapril (Vasotec)
   Eprosartan (Teveten)
   Fosinopril (Monopril)
   Furosemide (Lasix)
   Hydrochlorothiazide (HCTZ)
   Iosartan (Cozaar, Hyzaar)
   Irbesartan (Avapro)
   Lisinopril (Prinivil, Zestril)
   Metolazone (Zaroxolyn)
   Olmesartan (Benicar)
   Perindopril (Aceon)
   Quinapril (Accupril)
   Ramipril (Altace)
   Spironolactone (Aldactone)
   Telmisartan (Micardis)
   Valsartan (Diovan)

Blood thinners: Please make sure you have discussed this with your physician or surgeon before stopping these medications.

  • Aspirin – Stop taking 7 days before surgery
  • Coumadin – Stop taking 5 days before surgery
  • Heparin – Must be held for 12 hours prior to surgery
  • Antiplatelet agents (Plavix, clopidogrel, ticlopidine) – Please follow your surgeon or cardiologist’s recommendations.

Diabetes medications:
Insulin – Patient with insulin pumps:

  • Continue your basal rate ONLY

Patients without insulin pumps:
     On the morning of surgery:

  • Hold short acting insulin
  • Pre-mixed insulin (eg. 70/30): give 1/3 of usual dose
  • Lantus: give usual dose

Oral diabetic medications: do not take the morning of surgery

  • Metformin
  • Glyburide
  • Glipizide

Other prescription medications:

  • MAO inhibitors – do not take the day of surgery
  • Premarin – do not take on the day of surgery
  • Viagra or similar drugs – do not take 24 hours before surgery

Over-the-counter medications:

  • Aspirin – stop taking 7 days before surgery
  • NSAIDS (ibuprofen, Aleve, naproxen, Celebrex) – stop taking 7 days before surgery
  • Iron – do not take on the day of surgery
  • Herbal supplements and Vitamin E-containing multivitamins – stop taking 7 days prior to surgery

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Day Before Surgery

The Day Surgery department will call you the evening before your surgery to let you know what time to arrive. You will be asked to come to the hospital at least two hours before your scheduled surgery time. As a general rule, you will be asked not to eat or drink anything after midnight the night before surgery. Most often you can take your routine medications with a sip of water. Medication guidelines prior to surgery will be discussed at your pre-operative visit.

You should plan to stay overnight in the hospital and will likely be discharged the following morning (around 10am). Please leave all valuables at home and wear comfortable clothing.

Medications on Discharge
Common medications you may be prescribed on discharge:

  1. Pain medication

  2. Thyroid Hormone: (levothyroxine, Synthroid, Levoxyl). Depending on your pathology, you may be started on thyroid hormone immediately after surgery. Dosages of these medications are based on your weight. Typically your thyroid hormone levels will be monitored by your primary care physician or endocrinologist 4-6 weeks after surgery. Your dosage of medication will be adjusted as needed at that time.

  3. Calcium (TUMS): Some patients are discharged home with calcium after thyroid surgery. Your parathyroid glands, which control the calcium level in your body, may be temporarily injured. If you experience numbness or tingling around your lips or in your fingers or toes, this could indicate a low calcium level. If this happens, you will be instructed to take extra Tums and notify the surgeon’s office. This does not happen often and should resolve over time.

After Surgery

Approximately 1-2 weeks following surgery, you will return to clinic to meet with your surgeon. At this time you will also meet with a nurse or nurse practitioner who will review instructions regarding care for your incision. Your thyroid hormone level will be measured in 4-6 weeks with your endocrinologist or primary care physician. Your dosage of thyroid hormone will be adjusted at that time.

Questions you may have regarding your surgery:

What is the recovery like?
You should expect to return to work within 1-2 weeks. Typically recovery from surgery is short and pain is minimal. The most common complaints following surgery are fatigue, a sore throat and generalized soreness. These generally resolve within a week or two.

When can I go back to work?
You may return to work when you feel you are able. Some people will go back after a few days and some take up to two weeks.

When can I eat? What can I eat?
You may eat after surgery. There are no restrictions on what you may eat or drink. Some people experience a bad sore throat and prefer soft foods for a few days. It is recommended that you avoid heavy, greasy or spicy meals for the first few days.

What activities can I do?
You may resume your normal activities after surgery. There are no restrictions. You may feel more tired than usual which should resolve in a reasonable time after surgery. Light activity, like walking, is encouraged to help speed up recovery. Gentle neck exercises will help prevent neck stiffness after surgery.

When can I talk again?
You may talk immediately after surgery. Your throat may be sore but talking is highly encouraged.

How do I take care of the dressing over my incision?
Typically, Steri-Strips are placed over the wound. These are small strips of white tape which help to protect the incision. The Steri-Strips should remain intact for about 7-10 days. You may take them off after a week.

When can I shower?
You may shower 24-48 hours after surgery. We recommend that you leave the Steri-Strips intact while you shower and lightly dry them off with a towel when you are finished. You should avoid swimming, baths and hot tubs for at least 2 weeks following surgery.

What can I take for pain?
When you are discharged home from the hospital, you will receive a prescription for a pain medication. Do not take pain medication and Tylenol together. The pain medication contains Tylenol. If you wish, you may take ibuprofen, but no sooner than 5 days after surgery. Pain medication may make you constipated. You may use an over the counter stool softener if this occurs.

What will the scar look like?
Most scars will become soft, flat white lines over time.

Why is my scar red?
You will notice during the first few weeks after surgery that the scar area will become red, firm and hard. Scars often seem to become worse before they get better. This is normal. After about 6 weeks, the scar will begin to “mature”. This means that the scar will soften and become less red. Over the next 4 months, the scar will slowly become soft and will not be as red. It may take up to a year for the scar to mature.

When will the scars go away?
A scar is usually permanent. As the scar become softer and less red, it will begin to blend into the skin around the scar. It will become less visible.

Does putting Vitamin E oil on the scar help?
It is not known for sure if Vitamin E oil helps scars heal faster or makes them less visible. If you choose to use Vitamin E oil on the scar, it won’t hurt. Applying any oil or lotion that can add moisture to the skin will help. Starting one-two weeks after surgery, it is a good idea to massage a scar gently but firmly for 5 minutes, two to four times per day. Use oil or lotion of your choice when doing the massage.

What about sunlight and scars?
It is important to keep out of direct sunlight for up to one year after surgery. Too much direct sunlight makes a scar darker in color than the skin around the scar. You should use sunscreen with at least SPF 15 when outdoors.

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