- You arrive fasting, with your tests already done and your medications adjusted. The surgery is performed under general anesthesia, and the incision runs along a natural crease in the neck.
- In the first hours three things are monitored: bleeding, breathing and, if the whole gland was removed, calcium. That is why one night in the hospital is the norm.
- Same-day discharge is possible in selected patients, following criteria published by the American Thyroid Association.
Thyroid surgery varies in length, but the whole day follows a script, and it helps to know it beforehand. Below is that script as the guidelines describe it and as it works in practice. Dr. Jacobo gives you the exact details of your case in writing when the date is confirmed: the arrival time, how long to fast and which medication to take that morning.
Before that day
Almost everything is settled beforehand. The blood tests, the cardiology evaluation if needed and the voice assessment are already done. Blood thinners are adjusted days in advance, as directed by the doctor who prescribed them. And if you take levothyroxine or any other regular medication, you are told which ones to take that morning with a sip of water and which ones to skip. The day of surgery is organized so that there are no surprises: the You sleep completely and neither feel nor remember anything during the surgery. An anesthesiologist manages it from start to finish. is managed by an anesthesiologist who already knows your history, and the nerve that controls the voice is monitored with a A device that records the activity of the nerve that controls the voice during surgery and gives a signal if the nerve is being irritated. throughout the operation.
Arrival
- 01AdmissionYou arrive fasting, at the scheduled time, with your ID and your test results. Wear comfortable clothing, with no jewelry or nail polish. One person can come with you and wait.
- 02PreparationYour identity, the surgery and the side are confirmed. The anesthesiologist goes over the anesthesia and your allergies with you. An IV line is placed in your arm.
- 03The operating roomUnder general anesthesia, you are asleep and neither feel nor remember anything. The incision runs along a crease in the neck. The nerve that controls the voice is identified and monitored with the neuromonitor, and the parathyroid glands are protected.
- 04RecoveryYou wake up in a recovery room, under continuous monitoring during the first hours. Throat discomfort and a hoarse voice are expected. You can drink fluids shortly afterwards and eat soft foods that same day.
The first hours: what we monitor and why
Three things are monitored, and they are the reason one night in the hospital is the norm. The first is bleeding in the neck, which is uncommon but, when it occurs, happens in the first hours and needs immediate attention. The second is breathing, for the same reason. The third, if the whole gland was removed, is calcium: the parathyroid glands may work less for a while and calcium can drop, a transient Low calcium in the blood. After a total thyroidectomy it can occur for a few days. It causes tingling and is treated with calcium. that shows up on the next morning's blood test and is treated before it causes symptoms.
When you can go home the same day
It is possible in selected patients who meet defined criteria. The same American Thyroid Association statement describes when outpatient surgery is safe: a less extensive operation, such as removing half of the thyroid, no medical conditions that would complicate it, someone to stay with you that night, living or staying near a hospital, and a team that can respond quickly if anything changes. When those conditions are met, the results are as good as with an overnight stay. When they are not, staying the night is the prudent choice, and we tell you beforehand.
Same-day discharge
- Usually, removal of half of the thyroid
- No conditions that complicate anesthesia or bleeding
- With a companion that night and close to the hospital
- Calcium and voice in order at discharge
One night in the hospital
- Total thyroidectomy, or surgery that includes a lymph node dissection
- When the next morning's calcium needs checking
- When you live far away or have no companion
- When the team prefers to keep you under observation, which is the usual option
Neither option is better in the abstract: the choice depends on your surgery and your circumstances, and we tell you when the date is confirmed.
Discharge
- No bleeding or growing swelling, and normal breathing.
- Tolerating liquids and soft food without difficulty.
- With your voice checked: hoarseness is expected, and if your voice is weak or breaks, this is noted and followed up.
- With calcium in order if the whole gland was removed, and levothyroxine already prescribed.
- With written instructions: pain medication on a schedule, wound care, which warning signs should prompt a call and when your follow-up visit is.
- Terris DJ, Snyder S, Carneiro-Pla D, et al. American Thyroid Association statement on outpatient thyroidectomy. Thyroid. 2013, 23(10): 1193-1202.
- Haugen BR et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016, 26(1): 1-133.
- Edafe O et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014, 101(4): 307-320.
