In our clinical work we often encounter many patients with thyroid nodules, most of whom do not know much about their disease and often seek medical help in a hurry, which not only increases the cost of treatment, but also delays their condition. The answers to the most common questions raised by patients in our clinical work are as follows.
1. Why is there a pulling sensation in swallowing and even coughing sometimes after thyroid surgery?
This is related to the normal scar contraction response after thyroid nodule surgery. This is because, although there is only a line like scar on the neck after thyroid nodule surgery, the actual surgical trauma is much larger than this scar. This scar, like the incision on the neck, requires a normal scar reaction to recover, and during the scar reaction the scar will contract and pull on the trachea near the scar, causing a pulling sensation when swallowing and even irritating the trachea and causing a cough.
2.What is the purpose of taking thyroid preparations after surgery and how long do I need to take them?
The purpose of taking thyroid preparations after surgery is the following: to correct possible hypothyroidism, to prevent recurrence, and to avoid reoperation. Benign diseases without the appearance of hypothyroidism after postoperative follow-up can be discontinued after 3-5 years, but if hypothyroidism appears, the drug may be used for life. Malignant tumors mostly require lifelong medication and control of thyroid stimulating hormone as much as possible below the lower limit of normal, but without the clinical manifestation of hyperthyroidism.
3.What are the side effects of taking thyroxine preparation after surgery? Does long-term use have any effect on the body?
The main side effects of taking thyroxine preparations are headache, heartburn and hypertension. There are two types of thyroxine preparations, one is synthesized from animal raw materials, such as thyroxine tablets. This type of drug is not very pure because of more impurities, so it is not easy to control the dose when taking it. The other is synthesized from artificial raw materials, such as eugenol. This kind of drugs because the preparation is more pure, so when taking the dose is easy to grasp. However, no matter what kind of drugs you take, you need to check your thyroid function regularly to avoid excessive doses and drug-related hyperthyroidism. As long as the dosage is appropriate, long-term use of thyroxine preparations will not cause adverse effects on the body. There is no evidence of adverse effects on the fetus when taken by pregnant women, so pregnant women are allowed to take them.
4.What are the precautions for taking thyroxine preparations?
It is best to take thyroxine preparations in the early morning after waking up on an empty stomach, and eat breakfast about half an hour after taking the drug, so that the side effects of the drug can be minimized and the efficacy can be best. At the same time, avoid taking thyroxine preparations together with drugs for stomach problems to avoid affecting the efficacy of the drug.
5.Do I need to take other medications for a long time after surgery besides thyroid preparations?
Except for permanent hypothyroidism after surgery (which is relatively rare) that requires long-term supplementation of calcium preparations, there is no evidence from the current medical level that other drugs are beneficial for this type of disease, including the so-called blood-activating herbal preparations on the market. Therefore, if you encounter someone (whether medical or non-medical) who is trying to sell you on the need to take a certain drug for a long time, you must be wary of its purpose.
6.What is the purpose of thyroid nodule surgery?
Thyroid nodules are pathologically common as follows: nodular goiter, thyroid adenoma, thyroid cancer, etc., and can transform from anterior to posterior. Long-term growth of thyroid nodules can compress the tracheoesophagus and even fall into the chest, compressing the chest organs. Therefore, the purpose of thyroid surgery is clear: to make a clear diagnosis, to perform a second operation if necessary, to stop the progress of the disease, to relieve the compression, and to reduce or eliminate the physical pain and psychological burden.
7. Why is it that some patients still have nodules found during postoperative ultrasound of the thyroid gland?
Post-operative follow-up with nodules should be divided into the following cases.
(1) The knot of thread tied to stop bleeding during surgery.
(2) There were some very small nodules that could not be detected during surgery due to the current state of medicine.
(3) The patient has no normal tissue in the thyroid gland, and due to academic disagreement, or the patient and family not agreeing to a total thyroidectomy, there may be isoechoic nodules less than 1 cm in the thyroid tissue left behind after surgery.
(4) We cannot exclude the carelessness of the surgeon or the limitation of the level, and some nodules are left behind.
8. What should I do if a nodule is found in the remnant of the thyroid gland at the postoperative follow-up?
If the nodule does not grow within 2-3 years after surgery, no further medical intervention will be performed; if it grows gradually and the first surgery was done only to excise the mass and the diameter exceeds 2 centimeters, another surgery should be considered.
9.What if a patient who has already had a lobectomy and isthmus of the thyroid gland or a subtotal thyroidectomy for the first time has a recurrence after surgery?
As mentioned earlier, the purpose of surgery is clear: to stop the progression of the disease and to avoid the compression of important organs by the thyroid swelling. If the scope of the first surgery is large enough, although the recurrence is not suspected by the hospital examination, and there are no symptoms of compression on important organs, we generally recommend not to have the second surgery as much as possible to ensure the quality of life of the patient.
10. Although there is no hoarseness after thyroid surgery, why is there a change in pronunciation and difficulty in pronouncing high notes?
This is because the external branch of the superior laryngeal nerve was damaged during surgery. Most of the symptoms can be compensated in the months after surgery and have little impact on life, so most thyroid surgeons do not pay attention to them. As the standard of living improved, we found that patients continued to question this, so we investigated and found that the rate of damage to the extralaryngeal branch of the superior laryngeal nerve was as high as 15-20%, causing inconvenience to patients’ lives. The needs of patients are the direction of our work, so we began to study how to protect the external branch of the supraglottic nerve during surgery. From what we have done so far, we are avoiding damage to the extralaryngeal branch of the superior laryngeal nerve, and we are trying to reduce the injury rate to less than 1% by exposing it during surgery and then protecting it, rather than dissecting it.