Thyroid Cancer Surgery: Understanding the Risks

“The surgery itself is complex and delicate, but yet, it’s also a surgery that most people recover from very quickly,” Dr. Lisa Orloff, a head and neck surgeon at Stanford Medicine, tells SurvivorNet.

Possible Complications

Thyroidectomy is generally considered safe, especially when performed by a skilled and experienced surgical team. Even so, every operation carries some risk.

“Thyroid surgery tends to be a relatively low pain operation,” Dr. Ofloff explains. “Many thyroid operations are done as outpatient surgery. Sometimes patients are kept in the hospital overnight, but in general, people are able to resume eating and drinking and walking around, getting out of bed pretty much right away once they have recovered from the anesthesia.”

Your medical team will work together to try to minimize any potential risks and side effects.

The most common complications associated with surgery include:

• Nerve Injury
• Hypoparathyroidism (Low Parathyroid Hormone)
• Hemorrhage (Bleeding)
• Infection
• Esophageal or Tracheal Injury
• Difficulty Swallowing (Dysphagia)

Nerve Injury

“The thyroid gland is very intimately associated with the nerves that control vocal cord movement. So in any thyroid operation, there’s a possibility of injury, either temporary or permanent, more often temporary,” Dr. Orloff explains.

If either vocal cord nerve — the laryngeal nerve or the smaller superior laryngeal nerve — is affected, there can be a change in voice quality and control of vocal cord muscle, which Dr. Orloff notes can affect swallowing, coughing, projection, and even breathing.

“It’s important to have a dialogue between the patient and the surgeon and acknowledge the importance of those nerves and the aim to protect those nerves as much as possible. The rate of injury is very, very low, but it is something that needs to be prioritized,” she explains.

Recurrent Laryngeal Nerve Injury

• Why It Matters: the recurrent laryngeal nerve controls your vocal cords. If it’s harmed, you could experience changes in your voice or, in very rare circumstances, breathing difficulties if both nerves are affected.
• Causes: This nerve can be bruised or accidentally cut, especially if the cancer or enlarged gland is wrapped around it. Even gentle stretching can temporarily affect nerve function.
• Signs and Symptoms
  • Hoarseness: Your voice might sound weak, breathy, or harsh
  • Trouble Swallowing: If swallowing feels more difficult, this may point to nerve involvement
  • Weakened Cough: You might not be able to clear your throat as strongly
• Prevention and Management: Many surgeons use special devices, intraoperative neuromonitoring, to help them pinpoint the nerve’s location, lowering the chance of harm.
• Recovery: Most nerve injuries are temporary, lasting days to a few weeks. If the nerve is severely damaged, voice therapy or an additional procedure might be needed.
• Voice Rehabilitation: A specialist such as a speech-language pathologist can help you strengthen your voice if you experience ongoing issues.

Superior Laryngeal Nerve Injury: Less Obvious but Significant

• The external branch of the superior laryngeal nerve plays a role in voice pitch and singing. When injured, it might be less noticeable than recurrent laryngeal nerve damage, but it can still affect your ability to raise your voice or sing high notes.
• Studies show varying rates of injury because patients may not realize they have an issue, especially if they don’t regularly use a wide vocal range.
• If you notice changes in your ability to speak or sing at higher pitches, mention them to your doctor. Sometimes voice therapy helps, but injuries may be long-lasting.

Low Calcium

“The other structure that may not have been even something people have heard of but is present next to the thyroid gland are these little tiny glands called parathyroid glands. Parathyroid glands produce a separate hormone called parathyroid hormone that regulates calcium levels in the blood. And this is another function of the body that when it’s working fine, we aren’t even aware of it. But if we have a low level of calcium in our blood, we can develop muscle cramps and numbness and tingling and even more changes in muscles like the heart,” Dr. Orloff explains.

If the parathyroid glands are damaged during surgery, a patient may need to take calcium supplements. These supplements may be taken alongside vitamin D supplements, Dr. Orloff says.

“Calcium and vitamin D are usually temporary. The parathyroid glands, there are typically four of them, and they aren’t all necessarily affected by a thyroid surgery. So as long as somebody has a functioning parathyroid gland, they usually recover control of their calcium balance spontaneously,” she adds.

When calcium levels in the blood fall too low, you might notice:

• Tingling or numbness in the fingers, toes, and around your lips
• Muscle cramps or spasms
• In severe cases, difficulty breathing or painful muscle contractions called “tetany”

Your care team will measure your calcium levels frequently in the hours or days after surgery. Many hospitals use a “calcium protocol” to catch drops quickly.

Most people recover normal parathyroid function within a few weeks if the gland was only “stunned” or bruised. But if the glands were significantly damaged, you may need lifelong calcium and vitamin D to avoid symptoms.

Hemorrhage (Bleeding)

Postoperative bleeding isn’t very common, but it’s among the more serious risks.

• Why It Occurs: The thyroid gland has a rich blood supply. If a blood vessel reopens or wasn’t fully sealed during surgery, blood can collect rapidly in the neck area.
• Potential Danger: A large, rapidly forming hematoma (a collection of blood outside the blood vessels) can press on your windpipe, making it difficult to breathe.
• Symptoms: Sudden neck swelling, difficulty breathing, and/or a feeling of tightness or choking in the throat area.
• Immediate Action: Nurses and doctors will often check your incision frequently during the first hours after surgery, partly to look for signs of bleeding. If severe bleeding occurs, the surgical incision may be reopened to relieve pressure and stop the bleeding. In a dire emergency, this might happen right at the bedside rather than in an operating room.
• Outlook: Though hemorrhage can be frightening, quick intervention often resolves the problem. You may need another brief operation to ensure there are no more leaks.

Infection

About 6% of thyroidectomy patients can develop an infection at the incision site. The frequency is generally low,  but this can vary depending on your overall health, the specifics of the procedure, and hospital practices.

Signs of infection might include:

• Redness
• Warmth
• Swelling at the incision
• Fever
• Pus (if the infection is serious)

It is typically treated with antibiotics. Good surgical technique and proper wound care lower the risk.

Esophageal or Tracheal Injury

Though rare, accidental injury to these structures can happen if the thyroid growth is stuck to or pressing on them.

If recognized quickly, surgeons can repair the injury. Delayed recognition can lead to complications like infection in the chest, so careful postoperative monitoring is important.

Difficulty Swallowing

Dysphagia is a temporary swallowing issues that can result from normal swelling and scarring.

Most people improve gradually. Persistent swallowing problems may need further evaluation or speech therapy.

Although these complications can be alarming to read about, it’s important to remember that they are either rare or usually manageable. Experienced surgeons and careful postoperative monitoring help catch problems early so they can be treated promptly.

What You Can Do to Lower Risks

Like any surgery, a procedure to remove the thyroid gland does come with risks. However, patients can reduce their risk by following some basic guidance:

• Choose an Experienced Team: Surgeons who frequently perform thyroid surgeries tend to have fewer complications. Don’t hesitate to ask about your surgeon’s experience.
• Follow Instructions: If you’re asked to stop certain medications or fast before surgery, it’s vital to do so. These steps are to prevent bleeding or anesthesia complications.
• Speak Up: Before heading to the operating room, make sure your care team knows about all the medications (including herbal supplements) you take.
• Monitor Your Body: After surgery, if something seems off — like a rapidly expanding neck swelling, severe difficulty swallowing, or feeling faint and tingling in your hands, feet, or lips — contact your care team immediately.

While the list of potential complications is long, it’s important to weigh them against the benefits of removing a thyroid gland. In most cases, the chance to remove a harmful tumor or manage a dangerous hormone imbalance far outweighs the relatively small possibility of major side effects. Many people who undergo thyroid surgery go on to live normal, healthy lives. Those who do experience complications often find that modern treatments and therapies can help manage or correct these issues.

Questions To Ask Your Doctor

• What should I expect on the day of surgery?
• What do I need to do to prepare for surgery?
• How will I be monitored after surgery?
• What side effects should I be on the look out for?

Learn more about SurvivorNet's rigorous medical review process.

---