Post-Op Care

MINIMAL ACCESS THYROID SURGERY

Wound Care: Your wound will be covered with tape, which should be left in place for about 2 weeks as a thyroid surgery post op care. The tape will be removed at your first postoperative visit. You may notice some dried blood under the tape but that is of no concern. You can wash and shower with the tape in place and even get it wet. Once removed, the tape may need to be replaced and you will then need to change it every 2 or 3 days for the next 2 to 3 months in order to get the best possible cosmetic result. The preferred tape is narrow, flesh coloured Micropore, which can be obtained from your chemist.

Activities: There are no real restrictions on activities after minimally invasive thyroid surgery. For you thyroid surgery post op care, commonsense is the best way to avoid straining your neck.

Local symptoms: A variety of local symptoms are common for several weeks after surgery including tightness, swelling of the local area around the wound, choking, or having to force down food. Weakness of the voice with prolonged use may also occur. Occasionally a symptom may last for months.

Late complications: The only delayed complication of concern is wound infection.

This may have occurred if the wound becomes very red, hot and more swollen.

If that occurs you must seek attention from your local doctor straight away who will arrange for you to have antibiotics.

Follow-up: generally your follow-up for thyroid surgery post op care will consist of

• A visit at 2 to 3 weeks to have the tape removed. You will need to ring the office to make an appointment for that visit
• final surgical check up at 3 months

In addition, if you have been placed on calcium supplements, you may need to be seen by your local doctor on a weekly basis to have a blood test to check your calcium level, and to have your calcium supplements progressively reduced (see

“Calcium supplements” below). You will also need to be reviewed by your local doctor or endocrinologist at around 6 weeks and have thyroid function tests to check the function of your remaining thyroid. Your local doctor or endocrinologist may need to see you more frequently for specific review if there are any problems.

Country patients: If you are unable to return to Sydney for follow-up, it may be possible for the tape to be changed and for your follow-up to be undertaken by your local doctor. We would need to confirm these arrangements before you leave hospital.

Calcium supplements: A temporary drop in calcium levels may sometimes occur even after minimal access thyroid surgery. The calcium level is checked in hospital and if it is normal, you will be sent home on calcium supplements. You would then need to see your local doctor every week after discharge to have a blood test and to have the calcium levels checked. If, at each visit, the calcium level in the blood is normal, then the dose needs to be reduced according to the attached protocol that needs to be given to your local doctor.

If you have any problems, following your thyroid surgery, you should speak to your local doctor, who will arrange to contact your surgeon for your thyroid surgery post op care.  For a printable version of the post-operative instructions following a hemithyroidectomy (here) and total thyroidectomy (here)

MINIMALLY INVASIVE PARATHYROIDECTOMY

Wound Care: Your wound will be covered with tape, which should be left in place for about 2 weeks as a thyroid surgery post op care. The tape will be removed at your first postoperative visit. You may notice some dried blood under the tape but that is of no concern. You can wash and shower with the tape in place and even get it wet. Once removed, the tape may be replaced and, if so, you will then need to change it every 2 or 3 days for the next 2 to 3 months in order to get the best possible cosmetic result. The preferred tape is narrow, flesh coloured Micropore which can be obtained from your chemist.

Activities: There are no real restrictions on activities after a minimally invasive parathyroidectoms. Remember that for any thyroid surgery post op care, commonsense is the best way to avoid straining your neck.

Local symptoms: A variety of local symptoms are common for several weeks after surgery including tightness and swelling of the local area around the wound.

Late complications: The only late complication of concern is wound infection.

This may have occurred if the wound becomes very red, hot and more swollen.

If that occurs you must seek attention from your local doctor straight away who will arrange for you to have antibiotics.

Follow-up: Generally your follow-up will consist of

• A visit at 2 to 3 weeks to have the tape removed. You will need to ring the office to make an appointment for that visit
• final surgical check up at 3 months.

In addition, if you have been placed on calcium supplements, you may need to be seen by your local doctor on a weekly basis to have a blood test to check your calcium level, and to have your calcium supplements progressively reduced (see

“Calcium supplements” below). You will also need to be reviewed by your endocrinologist 2 to 3 months after surgery to monitor your progress. Your local doctor or endocrinologist may need to see you more frequently for specific review if there are any problems.

Country patients: If you are unable to return to Sydney for follow-up for your thyroid surgery post operatively, it may be possible for the tape to be changed and for your follow-up to be undertaken by your local doctor. We would need to confirm these arrangements before you leave hospital.

Calcium supplements: The calcium level falls to normal very quickly after successful parathyroid surgery. Sometimes this fall is associated with symptoms such as tingling around the mouth and in the hands and, very occasionally, cramping (“tetany”) of the hands and feet. A temporary drop in calcium levels below normal also sometimes occurs. The calcium level is checked in hospital and, if it is normal, you will generally not need calcium supplements. If the calcium level is low, you will be sent home on calcium supplements. If you are sent home on calcium supplements, you will need to see your local doctor every week after discharge to have a blood test and to have the calcium levels checked. If, at each visit, the calcium level in the blood is normal, then the dose needs to be reduced according to the attached protocol that needs to be given to your local doctor.

If you have any problems, following your parathyroid surgery, you should speak to your local doctor, who will arrange to contact your surgeon for your thyroid surgery post op care. For a printable version of the post operative care instructions for minimally invasive parathyroidectomy here and open aparathyroidectomy here

The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days . You can shower as normal. Following 10 days, the steristrip is replaced with a brown micropore tape. This can be changed every 2 days with the use of BIO Oil in between dressing changes. The use of the steristrip for 6 weeks post surgery minimizes scar stretching.

No driving is permitted for 2 weeks  following keyhole surgery and several weeks following open surgery. You may return to work within 2 weeks following keyhole surgery depending on the type of work you undertake and following open surgery this may take up to 2 months.

Symptoms to be worried about post surgery

Following discharge if you develop the following symptoms please contact me immediately:

1. Redness, heat or discharge from the wound.
2. A high temperature with night sweats.
3. Severe shortness of breath and/or chest pain
4. Nausea and /or vomiting

Parotidectomy

General information: The parotid glands are the largest of 3 major salivary glands. They secrete saliva into the mouth for chewing, swallowing and to begin the digestion of starches in food. It also helps to clean the mouth and keep it moist. The parotid salivary gland is situated in the cheek, immediately in front of and below the ear. A parotid gland can be difficult to remove due to its closeness to the facial nerve, an important nerve that supplies the muscles on each side of the face.

Treatment: The recommended treatment is usually surgery to remove the affected salivary gland. If the tumour is noncancerous (benign), no other treatment is usually needed. Surgery on the parotid gland usually helps maintain the function of the facial nerve, which controls the muscles of the face. Radiation therapy or extensive surgery may be required if the tumour is cancerous.

Possible complications of parotid removal: Cancerous tumours may cause further complications which may require further surgery or treatment. Rarely, surgery to the tumour can injure the facial nerve which runs through the parotid gland, which can lead to paralysis of the facial muscles, ranging from poor lip movement of failure of the eye to close, through to complete drooping of one side of the face. These injuries are often temporary. Infection of the wound may possibly occur, and antibiotics will be given if necessary. The ear may often feel numb after surgery but this will resolve by itself.

Surgery explained: The surgery is performed under general anaesthesia and may take anywhere from 90 minutes to over 3 hours, depending on the location of the mass. Where the mass is located relative to the facial nerve also determines how extensive the surgery will be. You may be able to go home the same day or stay overnight after surgery. The sutures will dissolve by themselves within a week or so.

Post-surgery: Pain around the area will be mild and can be managed with pain medication. You are able to eat whatever you want but cannot exercise or do any heavy lifting for the first 1-2 weeks after surgery. A common concern patients express about this surgery is whether this will affect their salivary production, and the answer is no.

Neck dressing (if applied) will be removed on the morning following your surgery. Please take a moment to look at the wound in the mirror prior to your discharge from the hospital. Mild redness and swelling around the wound is normal and will decrease over the 2 weeks following surgery.

Wound care: Do not wash or manipulate the neck wound for 48 hours following the surgery (except to apply ointment).

For a printable version of the post-operative care instructions (here)

Neck pain and stiffness is common following thyroid surgery. That’s why it is important to read, understand, and follow these instructions for thyroid surgery post op care. The neck is composed of vertebrae, ligaments that supply stability to the spine, and muscles that provide support and allow motion. The neck is very vulnerable because it is less protected than the rest of the spine, it supports the head, and it is very flexible.

During your surgery the neck is extended (bent backwards) for the duration of the procedure, which may be for several hours. This can cause muscle spasm, which then leads to pain and tension in the neck. People with pre-existing neck problems such as cervical spondylosis or a previous whiplash injury are more susceptible. Exercising the neck muscles before and after your surgery significantly reduces the risk of muscle strain and subsequent neck strain.

You should perform the following exercises for thyroid surgery post op care FOR 10 COUNTS EACH, TWICE DAILY, FOR 10 DAYS BEFORE AND 10 DAYS AFTER your surgery. Exercises should be done until a gentle tension is felt. Do not bounce or the muscle will tighten up more. It is important to return to the central position.

Please download these neck exercises for thyroid surgery post op care (pdf)