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.
Why is there a pulling sensation in swallowing and even sometimes coughing 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 wound is much larger than this scar. This scar, like the neck incision, requires a normal scar reaction to recover, during which the scar contracts and pulls on the trachea near the scar, causing a pulling sensation when swallowing and even irritation of the trachea that can lead to coughing.
What is the purpose of taking thyroid preparations after surgery and how long should I take them?
The purpose of taking thyroid preparations after surgery is the following: to correct possible hypothyroidism, to prevent recurrence, and to avoid reoperation. In benign diseases, the drug can be stopped after 3-5 years if no hypothyroidism appears after postoperative follow-up, but if hypothyroidism appears, the drug may be used for life. In malignant tumors, the drug is mostly needed for life and to control thyroid stimulating hormone as much as possible below the lower limit of normal, but without the clinical manifestation of hyperthyroidism.
What are the side effects of taking thyroxine preparations after surgery? Is there any effect on the body when taken for a long time?
The main side effects of taking thyroxine preparations are headache, heartburn and high blood pressure. 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 they can be taken by pregnant women.
What are the precautions for taking thyroxine preparations?
It is best to take thyroxine preparations in the early morning on an empty stomach after waking up and eat breakfast about half an hour after taking the medication to minimize the side effects and maximize the effectiveness of the medication. Also, avoid taking thyroxine preparations together with medications for stomach problems, as this may affect the effectiveness of the medication.
Besides thyroid preparations, do I need to take other medications for a long time after surgery?
Other than permanent parathyroidism after surgery (which is relatively rare), which requires long-term calcium supplements, there is no evidence from the current state of medicine that other medications are beneficial for this type of disease, including the so-called blood-activating herbal preparations on the market. Therefore, if you are approached by someone (medical or non-medical) who is trying to sell you on the need to take a certain medication for a long period of time, be wary of the purpose.
What is the purpose of thyroid nodule surgery?
There are several common pathologies of thyroid nodules: nodular goiter, thyroid adenoma, thyroid cancer, etc., and they 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 clarify the diagnosis, to perform a second surgery if necessary, to stop the progression of the disease, to relieve the compression, and to reduce or eliminate the physical pain and psychological burden.
Why are there still nodules in the thyroid gland when some patients undergo ultrasound after surgery?
There are still nodules in the post-operative follow-up 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) The carelessness or level of the surgeon cannot be excluded and some nodules are left behind.
What 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 is more than 2 cm, we should consider another surgery.
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 compression of the vital organs by the thyroid mass. If the scope of the first surgery is large enough, and although the recurrence occurs after surgery, no malignancy is suspected by hospital examination and there are no symptoms of compression of important organs, we generally recommend not to have a second surgery as much as possible in order to ensure the patient’s quality of life.
Although there is no hoarseness after thyroid surgery, why is there a change in the tone of pronunciation and difficulty in producing high notes?
This is because the external branch of the superior laryngeal nerve was damaged during surgery. Most of this symptom can be compensated in the months after surgery and has little impact on life, so most thyroid surgeons do not pay attention to it. 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 patient’s need is 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 rate of damage to less than 1% by exposing it during surgery and then protecting it rather than dissecting it.