Same day discharge: Hemithyroidectomy

You have been scheduled by your surgeon to undergo a hemi-thyroidectomy operation. You are well enough to be placed on a same day discharge hemi-thyroidectomy pathway. This leaflet tells you what to expect before and after your operation.

What is the thyroid gland?

The thyroid gland is a “butterfly” shaped gland with two lobes located in the front of the windpipe below the ‘Adam’s apple’. It consists of two lobes (right and left) joined by a small bridge of thyroid tissue called the isthmus.

The thyroid is an endocrine gland which produces thyroxine. Thyroxine is a hormone which controls the body’s metabolism and is vital for normal health.

What is a hemi-thyroidectomy?

A hemi-thyroidectomy is the removal of one of the lobes of the thyroid gland.

Before the operation

Prior to surgery, you will either be telephoned or seen face-to-face in the preoperative assessment clinic. This is to assess how fit you are for surgery and anaesthesia. During the assessment, your nurse will review your medical history and medications. They will also measure your height, weight and take some swabs to check for MRSA and COVID-19. They will explain the current COVID guidance about self-isolation prior to the operation. Finally, they may request some additional tests; these may include some blood tests, an ECG, chest x-ray and/or a urine sample. You will be advised on when to fast before the operation. Kindly arrange your own transport to and from the hospital. Finally, whilst you are on the same day discharge pathway please remember to pack an overnight bag and bring in your medications in case you need to stay overnight, though this is uncommon.

What to expect on the day?

You will be admitted on the morning of the operation and reviewed by a registered nurse, your surgeon and anaesthetist. They will be able to answer any questions you have. If you have not already had one in clinic, you may undergo a flexible nasendoscopy to examine your vocal cords in the voice box before your surgery. This is a small camera endoscope that passes through the nose to examine the voice box. It is very well tolerated and takes only a couple of minutes to perform while you are awake.

After the operation

You will wake up in the theatre recovery area and the recovery nurse will look after you until you are ready to go to the ward. Your nursing team will ensure that your pain is well controlled with pain relief medication. You will be able to have something to drink and a light meal. You will stay in hospital for a minimum of six hours after your surgery.

You will need to fulfil certain discharge criteria prior to going home: Adult supervision for at least 24 hours following surgery is essential. A post-operative assessment of the surgical wound will be carried out by the surgical team. This will include identification of any neck swelling, voice change, breathlessness or difficulty swallowing. If this assessment is satisfactory then you will be discharged. It is recommended that a flexible nasendoscopy is repeated after your surgery to examine your vocal cords - either before discharge or at your first outpatient follow-up appointment. This may be carried out by your surgical team or by another ENT doctor in the hospital. Any concerns raised by you, the medical and/or the nursing team may result in your day-stay being converted to a 23hr stay or longer inpatient stay with the agreement of your attending consultant.

Going home

After surgery, it is natural for you to feel tired, but most patients are able to return to their normal activities within a week. We would advise waiting two weeks before returning to work to ensure you are sufficiently recovered. We also recommend you avoid sports, or heavy lifting of any sort for at least four weeks. Your doctor will arrange an appointment to discuss the results of the surgery with you a few weeks after the operation.

Wound care

Your wound should be kept dry for seven days. After this, the dressing can be removed and you will be able to shower as normal. Your surgeon will use dissolvable stitches or an invisible glue which means you will not need to have any stitches removed after surgery.

The wound can often feel lumpy in the first few weeks. Using daily sun protection with a high SPF (SPF 50) for at least two months can prevent the scar becoming darker in colour. When your wound has completely healed, it can be gently massaged twice a day for the next few months with your fingertips to improve the appearance of the scar.

What to look out for

Whilst most people will have an uncomplicated recovery following hemi-thyroidectomy, there are important things you need to be aware of

• If you notice any large swelling under the wound incision or experience difficulty breathing, you should immediately attend the nearest emergency department or phone 999.
• If your wound becomes red, hot, painful or begins to discharge, you should seek medical advice from your GP or contact the secretary for your surgeon via Addenbrooke’s switchboard.
• If you experience muscle cramps, numbness or tingling of the fingers, toes or mouth, you should attend the nearest emergency department immediately or phone 999

Contacts / further information

• Addenbrooke’s day surgery unit:01223 256330 or 01223 216545
• The Head & Neck secretary via switchboard:01223 245151; ask for the operator and ask them to connect you to your consultant’s secretary.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas.