Thyroidectomy Complications—and How to Minimize Them

Support Your Body With Key Nutrients and Manage Stress for the Best Outcome

• Why You Might Need a Thyroidectomy|
• Signs and Symptoms of Thyroidectomy Complications|
• Strategies to Prevent Thyroidectomy Complications|
• Supporting Your Thyroid Hormone Levels After Thyroidectomy|
• Thyroidectomy Is a Safe Procedure|

Good news: Serious thyroidectomy complications are relatively rare. Some common complications post-thyroid removal surgery include hoarseness, difficulty swallowing, hypothyroid symptoms like weight gain and fatigue, and osteoporosis. Not everyone will experience all or even any of these issues, however.

Another bit of good news: You can work to prevent thyroidectomy complications by improving your nutrient status and overall health pre-surgery. Ensuring that your calcium, vitamin D, and magnesium levels are in optimal range is helpful for promoting a better post-surgical outcome [1].

Other supportive natural strategies to promote recovery include gentle neck stretching, massage, and voice therapy.

In this article, we’ll cover what you need to know about the thyroid removal procedure, thyroidectomy complications and side effects, side effect prevention strategies, methods to aid in recovery, and supporting your thyroid hormone levels post-thyroidectomy.

Why You Might Need a Thyroidectomy

Sometimes a thyroidectomy — partial or total removal of the thyroid gland — is necessary with certain conditions where the thyroid gland has been severely damaged. Possible reasons for this procedure may include [2]:

• Dangerous thyroid nodules
• Thyroid cancer (thyroid carcinoma; papillary thyroid cancer)
• Goiter (abnormal growth of the thyroid gland); multinodular goiter
• Hyperthyroidism
• Thyroid disease such as Hashimoto’s or Graves’ disease that has been unresponsive to treatment.

Other names you might hear to describe this surgical treatment include near-total thyroidectomy, subtotal thyroidectomy, thyroid resection, or thyroid lobectomy (removal of one of two thyroid lobes). Parathyroid surgery, removal of one or more of the parathyroid glands on the back of the thyroid, is called parathyroidectomy. The parathyroid glands secrete parathyroid hormone (PTH), which helps regulate blood calcium levels [3].

All of this being said, it’s important to keep surgery as a last resort, and we’ve seen many patients in our clinic recover from thyroid disorders, dysfunction, and endocrine issues, including hyperthyroidism and hypothyroidism, without surgery. If you want a second opinion on your thyroid health, please reach out to us at the Ruscio Institute for Functional Medicine. 

If you do need to go through with surgery, know that thyroidectomy has shown to significantly improve patient quality of life compared to pre-surgery [4].

The Thyroidectomy Procedure

During the surgical procedure to remove part (partial thyroidectomy) or all (total thyroidectomy) of the thyroid gland, the patient is first put under anesthesia. A small incision is made in the front of the neck to access the thyroid gland. Careful attention is paid during the operation to avoid damaging important anatomical structures that are in close proximity to the thyroid gland. Once part or all of the thyroid has been removed, the incision is closed.

The most important surrounding structure surgeons must be aware of is the recurrent laryngeal nerve (RLN). Damage to this nerve can result in voice impairment and difficulty swallowing. Recurrent laryngeal nerve injury during thyroid surgery is rare (an average of 2-6% risk of injury) and postoperative complications are usually temporary [1].

Signs and Symptoms of Thyroidectomy Complications and Side Effects

The most serious potential complications of thyroid surgery are 1) damage to the recurrent laryngeal nerve, which we’ve already mentioned, and 2) the development of permanent hypoparathyroidism.

Hypoparathyroidism results in low parathyroid hormone (PTH) levels and low blood calcium. This condition may be caused by damage, removal, or disruption of the blood supply to the parathyroid glands [5] and may occur with partial or total removal of the thyroid gland. But once again, both of these complications are relatively rare.

Other complications and side effects may include [1, 2, 6, 7, 8]:

• Temporary hypoparathyroidism (lasting weeks to months)
• Low blood calcium (hypocalcemia)
• Post-surgical infection
• Hoarseness
• Difficulty swallowing (dysphagia)
• Mild weight gain
• Hypothyroidism
• Increased risk of osteoporosis 
• ​​Vocal cord paralysis
• Nerve palsy
• Injury to the superior laryngeal nerve (possibly causing decreased ability to tense the vocal cord and decreased vocal power)
• Hematoma (a rare complication that can lead to airway obstruction)

A 2021 observational study attempted to figure out how common complications are following thyroidectomy. A total of 161,534 patients were analyzed and the results showed that the overall complication rate of thyroidectomy was just 3.28% [9].

Another observational study wanted to see how total thyroidectomy surgery affects quality of life. A total of 729 patients who underwent total thyroidectomy filled out a questionnaire to assess quality of life before surgery, as well as two and six months after surgery. The results showed that quality of life improved significantly at two and six months post-thyroidectomy compared to before surgery [4].

One study examined a group of 204 patients who underwent thyroidectomy to see what short-term and long-term complications arose after surgery. The results showed the following [10]:

Within three months of surgery:

• Low blood calcium (postoperative hypocalcemia) (54.4%)
• Hoarseness (33.3%)
• Difficulty swallowing (32.8%)
• Wound infection (3.4%)

More than three months after surgery:

• Low blood calcium (6.2%)
• Hoarseness (8.2%)
• Difficulty swallowing (3.6%)
• Wound infection (0%) 

Overall, this study highlights the most common side effects of thyroidectomy, and that most incidences are likely to resolve in patients with time.

Strategies to Prevent Thyroidectomy Complications

How can you increase your chances of coming out of thyroid surgery without any complications or side effects? You can start with a solid nutritional foundation that includes optimal calcium levels, along with vitamin D and magnesium. 

Of course, you can incorporate foods that supply these nutrients in your diet such as dairy, leafy greens, and fatty fish. You can also prioritize daily sun exposure (for vitamin D) and getting enough rest. (Stress quickly depletes minerals like calcium and magnesium [11].) But according to research, supplementing these nutrients is also quite beneficial pre-surgery. 

Two systematic reviews and meta-analyses found that taking calcium and vitamin D significantly reduced the risk of having low blood serum calcium following thyroidectomy surgery [12, 13].

Another study showed that vitamin D deficiency was significantly associated with development of permanent hypoparathyroidism after thyroidectomy [14].

Other factors to address preoperatively include improving metabolic health, improving

diabetes and heart health, quitting smoking, addressing anemia, and reducing overall inflammation in the body [7, 15, 16, 17, 18].

Having type 2 diabetes, heart conditions like congestive heart failure, high blood pressure, and anemia all were all significant risk factors for having complications post-thyroidectomy [15, 16]. An SR/MA of 32 studies found that patients with high levels of inflammation had a 39% higher risk of developing hypothyroidism than patients with no or low levels of inflammation after thyroidectomy [7].

Post Surgery Support for Thyroidectomy

During the recovery phase, there are a few strategies you can try to support your healing and avoid thyroidectomy complications. Different studies showed:

• Performing neck stretches may reduce short-term pain and disability after thyroidectomy [19].
• Kinesiotaping was associated with significantly less pain medication use shortly after thyroidectomy [20].
• Self-massage of the neck (where surgery was performed) may improve surgical adhesions, neck pain/discomfort, swallowing discomfort, vocal cord discomfort, and voice impairment [21].
• Voice therapy may improve voice quality after thyroidectomy [22].

Of course, you’ll also want to make sure your ideal diet is in place and that you’re taking good care to rest and reduce your stress (physical, mental, and emotional) post-surgery. 

Supporting Your Thyroid Hormone Levels After Thyroidectomy

It’s essential for patients who have undergone a thyroidectomy to remain vigilant about taking their prescription thyroid hormone. With follow-up care, patients should have their TSH levels monitored every six to eight weeks after thyroidectomy until their thyroid hormone levels are normalized and an optimal dose is achieved [23]. Most patients (70%) will require thyroid hormone dose adjustments after thyroidectomy [24], as overtreatment or undertreatment can result in hypo or hyperthyroid symptoms [23].

A few standard recommendations for taking thyroid medication include:

• If taking levothyroxine orally, take on an empty stomach at least 30 to 60 minutes before breakfast or three to four hours after dinner [25].
• Do not administer levothyroxine within four hours of administration of products that may contain iron or calcium [25, 26]. This is particularly important for thyroidectomy patients who have to supplement calcium due to hypoparathyroidism.
• Do not take levothyroxine with antacids or proton pump inhibitors [25, 26].
• Separate fiber and soy consumption from levothyroxine intake by at least one hour [26].
• Wait at least one hour after taking levothyroxine to consume coffee [26].

Another way to ensure that your body is absorbing supplemental thyroid hormones is to maintain good gut health. This may include interventions like addressing food allergies and sensitivities, promoting diversity of good bacteria in the gut by taking probiotics and eating prebiotic foods, and addressing any GI conditions like celiac disease and H. pylori infection [27, 28, 29].

A randomized controlled trial gave 60 adults with hypothyroidism prebiotics and probiotics, and found high-quality evidence that probiotics can reduce the need for thyroid medication. This is likely due in part to the fact that probiotics can fight H. pylori infections and SIBO, two gut conditions strongly associated with hypothyroidism.

Thyroidectomy Is a Safe Procedure

Any surgery should be approached with caution, but thyroidectomy has proven to be a safe and effective treatment when needed. 

If you’ve been told you need thyroid surgery and you want a second opinion, or you’re looking for support following the procedure, please reach out to us for a consultation at the Ruscio Institute for Functional Health.

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