After thyroid cancer surgery, a few patients experience breathing difficulties and even choking, which sounds scary. So, why do they happen? How will doctors respond? What do you as a patient (family) need to be aware of?
Why might thyroid surgery cause dyspnea?
Transient laryngeal edema
Thyroid cancer surgery requires general anesthesia, and irritation from tracheal intubation may lead to postoperative laryngeal edema, which can cause dyspnea. Patients with a history of respiratory disease (e.g., chronic bronchitis, asthma, etc.), or who smoke, have difficulty draining postoperative airway secretions that collect in the edematous airway and can exacerbate dyspnea.
This dyspnea is usually temporary, and your doctor will provide oxygen and intravenous medication to relieve it. You will also need to work to expel the sputum and learn and master appropriate coughing before surgery.
What are some tips for “coughing practice”? See the “extended reading” at the end of this article.
As a family member, you need to pat your patient’s back regularly to promote the removal of airway secretions.
Collapsed trachea
In patients with large primary thyroid tumors, the trachea is compressed for a long time and the tracheal wall loses its elasticity. After the tumor is removed, the trachea collapses.
In response, the surgeon evaluates the airway intraoperatively. If it is thought that there is tracheal softening that could lead to tracheal collapse, a tracheotomy or tracheal suspension will be done to ensure airway patency.
Postoperative bleeding compressing the trachea
With a small gap in the neck area and the trachea on the back of the thyroid, a large amount of bleeding can cause compression of the trachea, leading to respiratory distress and even asphyxia in severe cases.
In response, the doctor will first investigate the cause of the bleeding, try conservative treatment, and observe closely. If it doesn’t resolve, you may need to operate again quickly to remove the clot from the surgical area, look carefully for bleeding spots, and complete hemostasis.
Related reading:
Bilateral recurrent laryngeal nerve injury
The recurrent laryngeal nerve (RLN) is located immediately behind the thyroid gland, one on each side. They control vocal fold activity, regulate the position and opening and closing of the vocal folds, and maintain our airway function and articulatory function. We can say that our ability to speak and sing properly, eat and drink (swallow), all depends on the hard work of the laryngeal retrolateral nerve.
If surgery damages both sides of the recurrent laryngeal nerve, in addition to causing hoarseness, it can lead to difficulty breathing and even choking. This requires an immediate tracheotomy for relief.
The incidence of permanent bilateral recurrent laryngeal nerve injury is low, and the vast majority of injuries are temporary. The incision can be closed after the tracheotomy, after the period of nerve injury has passed, and after the surgeon has confirmed that the vocal cords can close on their own.
Related reading:
Post-op breathing difficulties, what should I do?
You and your family need to recognize signs of respiratory distress early. Notify your doctor as soon as you notice any of the following so they can be managed promptly:
- Struggling to breathe or needing to open your mouth to breathe;
- Increased and thickened breathing sounds;
- Purple lips and mouth;
- Irritable temperament;
- Oxygen saturation on the cardiac monitor (an indicator of the degree of tissue hypoxia and respiratory function. In English, it is SPO2, where: S refers to saturation, P refers to pulse, and O2 refers to oxygen) decreases or even alarms.
Extended reading:
Coughing up sputum in this position is correct
Coughing with your breath
First, sit up and keep your upper body in an upright position. Some patients who cough with their throat after surgery can hear as if it’s just their throat making an effort and not very effective at expelling sputum. Always remember to let your stomach or chest cavity come under pressure when you cough up sputum. We suggest you try this: take a deep breath in, then make a small, even “a” sound, and then exhale with your stomach, and you will find yourself “coughing” out. The family members can also feel it.
Stimulating the tracheal cough
You can also induce a cough by stimulating the airways. The nerves around the trachea feel the stretch and sometimes the person coughs involuntarily for a while, but not everyone is sensitive to it.
Co-written by Dr. Jiaqian Hu, Cancer Hospital of Fudan University Dr. Xing Wang, Cancer Hospital of Peking University