Instructions for thyroidectomy
before and after surgery

The most important of the instructions for thyroidectomy is your surgery to be performed by a specialized and experienced thyroid surgeon, who performs these operations very often. Do not hesitate to ask your surgeon any questions you may have, such as the number of thyroid surgeries he or she performs. Ask him out well if he is no longer absorbed in the connection, and focus on any complications that may arise during the course of the surgery. When you are about to have surgery, your right to participate in decision-making is recognized. It is such an important issue and you will be asked to give your consent before the surgery.

Instructions for thyroidectomy before surgery

Diet

If you have hyperthyroidism (Graves), it is very likely that we recommend that you take medication for a few days before surgery. We recommend that you take medication (such as iodine and potassium solution – Lugol) to regulate your thyroid function and reduce the risk of bleeding. We may also give you treatment for tachycardia, which is common in patients with hyperthyroidism or a vitamin. Your pre-surgery diet may need to be a high-protein, high-carbohydrate diet.

Before your scheduled surgery, you will need to have tests done to assess your thyroid. The test may include a blood test for thyroid hormones, an ultrasound, and / or a fine needle aspiration biopsy (FNA).

There will be a series of general examinations to assess your health and to see if you need any special preparation to undergo surgery. These are usually performed a few days before surgery. The preoperative examination includes taking your medical history, clinical examination and laboratory tests. There will be blood tests, a chest x-ray, an electrocardiogram and an examination by a cardiologist and you will usually be examined by an anesthesiologist. You do not need to stay in the hospital for your preoperative examination.

Some medicines may need to be stopped or replaced (anticoagulants) before surgery. We will explain this to you in every detail, it is not right to do something on your own.

Preparing for your surgery

You and our team will work together to prepare you as best we can for your surgery. We will take your history in great detail and you in turn, let us know if any of the following happen, even if you are not sure.

• I am taking anticoagulants or aspirin.
• I take medicines without a prescription
• I take dietary supplements such as herbs, vitamins, minerals and natural or home remedies.
• I have a pacemaker.
• I get apnea when I sleep.
• I have had a problem with anesthesia in the past.
• I’m allergic to certain medicines.
• I drink alcohol.
• I am smoking.
• I use drugs.

About alcohol consumption

The amount of alcohol you drink can affect you during or after surgery. It is important, if you drink, to tell us about how much alcohol you drink. This will help us plan your care.

• Sudden cessation of alcohol can cause seizures, delirium. If we know you are at risk for these complications, we can help you with medication and prevent them.
• If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems and longer hospital stays.

Here are some things you can do to help prevent problems before surgery:

• Be honest with us about how much alcohol you drink.
• Try to stop drinking alcohol as soon as surgery is scheduled. If you experience headache, nausea, increased anxiety or can not sleep after you stop drinking, let us know. These are early signs of alcohol withdrawal and can be treated.
• Let us know if you can not stop drinking.
• Ask us any questions you may have about alcohol and surgery.
• AS ALWAYS ALL YOUR MEDICAL INFORMATION REMAINS CONFIDENTIAL

Within 30 days of your surgery

Pre-operational check

Before the surgery, you will have an appointment for your preoperative examination.

It is very helpful to bring the following things to your appointment for this check:

• A list of all medications you are taking, including prescription and over-the-counter medications.
• Results of any heart tests you have, such as heart or carotid triplex, etc.

Let us know which relative or loved one you want to inform about your situation

• Follow a healthy diet
• Eat a balanced, healthy diet before surgery.
• 10 days before surgery
• Stop taking vitamin E.

If you are taking vitamin E, stop taking it 10 days before surgery. Taking vitamin E can cause bleeding.

7 days before surgery

Stop taking certain medications

If you are taking anticoagulants or aspirin, you should stop taking them and we will have fully explained to you what medicine you should replace them with. Anticoagulants and aspirin can cause bleeding.

Stop taking herbs and other supplements

Stop taking herbs and other supplements 7 days before surgery.

2 days before surgery

Stop taking certain medications

Stop taking non-steroidal anti-inflammatory drugs (NSAIDs). These drugs can cause bleeding.

1 day before surgery

Make a note of the time of your surgery

A member of our team will call you by 8:00 p.m. the day before surgery. If you have surgery scheduled for Monday, they will call you the Friday before.

Our partner will tell you what time to get to the hospital for your surgery. It will also tell you where to go on the day of your surgery. If you do not receive a call by 8:00 p.m. , call 6986989220.

Sleep

Go to bed early and try to get a good night’s sleep.

Instructions for eating and drinking before surgery

• Do not eat indigestible or heavy foods the day before the operation. Prefer homemade food and do not order something from outside. Do not eat anything after midnight the night before surgery. Depending on the time your surgery is scheduled, we will explain by what time you can drink water.
• Schedule an overnight stay at the hospital on the day of your surgery.

The morning of the day of your operation

Take your medication

If we have advised you to take certain medications on the morning of your surgery, only take these medications with a sip of water. Depending on the medication you are taking and the surgery you are having, we may have told you to take all, some or none of your usual morning medications.

Things to remember

• Do not wear lotion, cream, deodorant, makeup, powder, perfume or cologne.
• Do not wear metal objects. Remove all jewelry. Equipment used during surgery can cause burns if it touches metal.
• Leave valuables in your home, such as credit cards, jewelry, or your checkbook.
• Before being transported to the operating room, you must remove the hearing aids, dentures, prostheses.
• Wear something comfortable and relaxed.
• If you wear contact lenses, wear your glasses. Using contact lenses during surgery can damage your eyes.

What to bring

• Your breathing apparatus for sleep apnea (such as CPAP), if you have one.
• Your portable music player, if you wish.
• Your mobile phone and your charger.
• A case for your personal items, such as glasses, hearing aids, dentures, prostheses, wig, if you have one.

Before surgery

When the time comes for surgery, you will enter the operating room on a stretcher. The surgeons perform the thyroidectomy while the patient is under general anesthesia, so during the operation you will not be conscious after you sleep. Your anesthesiologist will give you an intravenous (that is, a venous catheter) anesthetic in a vein and provide you with oxygen with a mask. The medicine may make you feel cold or stingy as it enters your body, but it will quickly put you to deep sleep. A breathing tube will then be inserted into your trachea to supply you with oxygen throughout the operation.

Your anesthesia team puts several cables in your body, which are connected to monitors to control the basic functions of your body. It must be ensured that your heart rate, blood pressure and blood oxygen levels remain safe throughout the operation. These cables include a blood pressure cuff on your arm. They also include cables connected to an electrocardiograph to monitor your heart rate and placed on your chest. There will also be a cord that carries an oximeter, is placed on the thumb and measures the percentage of oxygen in your blood.

To perform the operation, the position you will be in is supine and a pillow will be placed under your back and shoulders. This is done after you have been given anesthesia and the purpose is to have your throat exposed and your thyroid more easily accessible.

During the operation

Thyroidectomy Stavros Tsirigotakis

Once you have been anesthetized, we will make a small incision in the center of your neck, low. We often try to do it in an aspect of the skin where it will be difficult to distinguish it after a while. Then the whole thyroid gland is removed.

If you are having surgery for thyroid cancer, we may also have lymph nodes removed around your thyroid and neck. This will be determined before the surgery by examining the mapping you have undergone and co-deciding with your surgeon. Thyroidectomy usually lasts 60 minutes. It may take more or less time, depending on the extent of the surgery required.

After surgery

After the surgery, the breathing tube is removed and since you do not need anything else, you are transferred to a recovery room. There your anesthesia team monitors your recovery from surgery and anesthesia. In the recovery room you will wake up almost completely and our staff will make you feel comfortable. Once you are fully awake, you will move to your room upstairs. You will have an intravenous line through which you will be given a serum for a few hours, until you are fully awake. In a few hours you will be able to take fluids by mouth, at which point the serum will be removed.

During surgery, your family or loved ones may be waiting in the waiting area. They will be informed by the staff of the operating room about the progress of the operation. Thyroid surgeon Stavros Tsirigotakis will talk to them after the completion of the surgery. You will indicate to us who you wish to inform.

In some patients, a tube (drainage) may need to be placed next to the surgical wound. This is placed to remove any fluid that may be present in the wound. The drain is usually removed in the morning after surgery.

How will I feel after the surgery?

Minimally invasive thyroidectomy Stavros Tsirigotakis thyroid surgeon

Every patient is different. You may feel tired and you may have discomfort not only in your incision but also in your back and shoulders. This is due to the position you had in the operating room during the surgery.

You may feel an annoyance like an abrasion in the throat, this is a result of the placement of the anesthesia tube during the surgery. Lozenges usually help and you may feel this for 1-2 days. Your calcium level may drop after surgery, this is rare but as a possibility. This is related to a disorder of the parathyroid gland, which regulates calcium balance. The next day of the operation, a blood test will be done to determine the calcium and parathyroid hormone. If your calcium is low then you will only be given calcium. When calcium falls you may notice numbness and tingling in your fingers or around your mouth. This happens very rarely and usually all of our patients can be taken home the day after surgery.

Can I lose my voice in thyroid surgery?

It goes without saying that you should not lose your voice after thyroid surgery. Thyroid surgeon Stavros Tsirigotakis emphasizes that the nerve responsible for speech may be temporarily paralyzed and hoarseness may occur, but you should not lose your voice. If a person has a problem with their voice as a result of thyroid surgery, this may be temporary, it may be due to an unintentional injury to the nerve or an injury while trying to protect it. For example, when cancerous lymph nodes are removed, the nerve must be protected and removed from the lymph nodes so that they can be safely removed. There are two options in this case, one is not to remove the lymph nodes since they are stuck on the nerve so as not to injure it, but this is not right. The second option and the one that is correct is to remove the lymph nodes above the nerve, so that the operation is radical. In this case, we must “detach” the lymph nodes above the nerve, so it makes sense that there is some kind of injury.When looking for a surgeon to operate on you and remove your thyroid, you should ask your prospective surgeon how often he or she performs such thyroid surgeries and how often a patient loses his or her voice.An excellent surgeon will tell you that the risk is almost zero, or much less than 1%. If your surgeon says 2% or more, then you may want to discuss this with another surgeon. Experienced surgeons have the lowest complication rate. Monitoring the nerves with a special machine does not prevent nerve injury and actually gives the surgeon a false sense of security because he believes he is protected. What prevents nerve damage is for your surgeon to see the nerve and keep it whole along with all its branches. A surgeon should be able to tell you that the risk of nerve injury is less than 1%, if not, he is not the right surgeon for your thyroid. If he says that he is going to machine monitor your nerve in the operating room to prevent an injury, then you know that this is not entirely true and often this increases the risk of nerve injury. These machines are used to protect the surgeon from treatment and not to protect the patient’s nerve from injury. What prevents nerve damage is for your surgeon to see the nerve and keep it whole and intact along with all its branches.

Can surgery affect my parathyroid glands?

The parathyroid glands are 4-6 small glands, located next to or sometimes inside the thyroid. They control the balance of calcium in your body. Your surgeon will make every effort to maintain them, but even in the best hands their blood supply may be affected. This is a result of the surgeries performed on the thyroid surgeries. May result in temporary shutdown. In addition, one or more parathyroids may inevitably be removed (this is usually the case with lymph node dissection procedures). If this happens, it can lead to hypoparathyroidism (low blood calcium) which can be temporary or permanent. Fortunately, all 4 parathyroid glands are not necessary to regulate calcium levels, the function of one can be offset by the others. But sometimes it takes days, weeks or even months after surgery for the rest of the parathyroid to be able to fully control your calcium balance.

If you feel tingling in your hands, fingers or around your mouth after surgery, you should notify medical staff immediately. This may be a sign that your calcium levels have dropped, and is usually the result of a reduced blood supply or damage to one or more parathyroids.

The blood test to check the calcium level is done the next morning after the operation. If it is low, you will be given calcium and vitamin D pills. This is the most common cause of delayed discharge from the hospital.

The parathyroid glands often regain their function within six to eight weeks. After total thyroidectomy a very small percentage of patients may have permanent hypoparathyroidism. These patients will need to take calcium and / or vitamin D for the rest of their lives. Lymph node surgery for thyroid cancer increases these risks.

On your way out, you may be prescribed the following medications:

• Pain medications are NEVER prescribed, as there is no pain.
• We may recommend that you take an antibiotic and anti-inflammatory as a precaution.
• Your parathyroid glands control the level of calcium in your body. These glands may be temporarily injured. Therefore, some patients may be prescribed calcium or some vitamin to take for a few days at home. Although rare, a numbness or tingling in your lips or fingers or toes may indicate a low calcium level. If this happens, you should contact your surgeon immediately.
• Treatment with thyroid hormone replacement medicine will usually begin after the histological examination (biopsy) is completed. This is usually done 5-10 days after surgery. Your endocrinologist will prescribe the appropriate medication, depending on your problem and body weight.
• If you were taking medication for any other reason before the operation, you will usually be able to start it the day after the operation.

After surgery

You will be back in 2-3 days to have your wound checked. This does not have to be done and if you live outside Athens, you will be given detailed instructions on how to treat it. It is something very simple.

After the surgery you may feel a discomfort in the neck. This is because the position you are in for surgery is with your head extended. This posture helps the surgeon, as this way your throat is well exposed. This annoyance will subside in a few days.

The experience and stories of our patients

Patients tell us that the quality of our services, our attention to detail and the effectiveness of the operations we perform, are a pleasant surprise for them.

Visit our website www.xeirourgos–thyroeidh.gr to read real stories and the experience of our patients, after the operation we performed on them. If you wish it is possible to talk to them..

Do not forget!

It is generally best to rest 2-3 days after surgery.

Do not go on vacation for about 10 days after surgery.

If non-absorbable sutures are used, then they should be removed after a week.

When to contact us directly

You should call +306986989220 if you experience the following symptoms:

• Fever, with a temperature higher than 38.5.
• If there is pain that did not exist
• Numbness or tingling in the fingers or toes or around the mouth.
• Muscle cramps
• Breathing difficulty

Follow-up visit

Your next appointment after discharge will be scheduled 2 or 3 days after surgery. Please call 6986989220 to book your appointment.

How is the recovery?

Recovery is usually very short and there is no pain. The most common complaint is the appearance of fatigue, which generally subsides within a few days.

When can I return to work?

Recovery varies, but most people return to work a few days after surgery. Those who have their own job, usually return after 1-2 days. The sick leave that one can get from his insurance fund, however, is more than 15 days.

When can I eat? What can I eat? Should I follow a special diet?

There are no restrictions on anything you want to eat or drink after surgery. Few patients experience a sore throat or worry that something might happen and prefer to eat soft foods for a few days. It is recommended to avoid heavy, fatty or spicy meals for the first few days.

What activities can I do?

There are no restrictions on normal activities after surgery. You may feel a little more tired than usual, but that goes away quickly. Light activity such as walking is encouraged by us to speed up recovery. The exercises we recommend you do will help prevent a slight stiffness that may occur after surgery. These exercises are available on our website, where you can find information.

When can I talk again?

You can speak immediately after surgery. We ourselves encourage you to speak.

How do I take care of the bandage on my incision?

We usually place a small sticker over the incision. This will be there for six to seven days. It will then be removed. For all these days we recommend that you moisturize the wound.

When can I take a shower?

We recommend that you do not wet the wound for a few days. But if you want to take a shower right away, we will place a waterproof bandage on the incision. Avoid swimming, bathing and hot tubs for at least 2 weeks after surgery.

What can I get for the pain?

You will not need to take painkillers, as you will not be in pain. But if you want to take it for any reason, then you can take any common painkiller you want.

What will my scar look like?

Most scars will be soft, flat white lines and will be difficult to distinguish after 2-3 months. In some people, however, it can become red and thick. This is called a hypertrophic or keloid scar. Keloids are more common in young people, especially those with red hair, but they can occur to everyone unpredictably, but fortunately this is rare. If you have had problems with scars in the past, let us know.

Why is my scar red?

In the first few days after surgery, the scar may be red and a little hard. This is normal. In the coming months, the scar will mature, become softer and difficult to distinguish.

Πότε θα εξαφανιστούν οι ουλές;

Η ουλή είναι συνήθως μόνιμη. Με την πάροδο του χρόνου όμως θα είναι ορατή με δυσκολία.

When will the scars disappear?

The scar is usually permanent. Over time, however, it will be visible with difficulty.

Does the application of Vitamin E oil to the scar help?

Vitamin E oil has not been shown to help scars heal faster or become less visible. Coating the incision with oil or moisturizing lotion will definitely help. One to two weeks after surgery, it is a very good idea to massage your scar gently but firmly (using oil or lotion) for five minutes, every day.

What about sunlight and signs?

Avoid exposing the incision to direct sunlight for up to a year after surgery. Exposure to direct sunlight makes the scar darker in color than the skin around it. It is advisable to use sunscreen at least when outdoors.