I recently had thyroid surgery. Ultrasounds and biopsies (“fine needle aspirations” meaning someone pokes numerous sharp needles into your neck) revealed a cancerous nodule on the right side of my thyroid, approximately one and a half centimeters big. Odd, because it was the left side of my thyroid that had been swollen for many years. Because of that swelling, I’d purchased several books about thyroid back around 2006, but I'd only read parts of them. Now I got the books off the shelf and read the sections about cancer. One centimeter is the size of nodule that invokes surgery.
There are about 150,000 thyroidectomies performed annually in the U.S., usually because of cancer. Doctors wax enthusiastic, proclaiming that if you have to get cancer, thyroid is the one you want, as it’s “easy” to cure. However, as we know, surgeons tend to gloss over the unpleasant consequences of surgery. I thank heavens for online support forums that discuss various problems, as it would be dreadful to suffer unexpected problems. A common and distressing result of the surgery is change of voice. Rod Stewart had thryroid surgery in 2000. Here he is quoted on the website rockcelebrities.net: “I don’t want to pretend I fought cancer for months and months. It was really easy to get rid of, but I did lose my voice, totally gone. It was scary because I couldn’t sing a note….all the muscles are torn apart,….it took me six months to get it back again.”
On the website Steady Health, several people posted about this problem. One wrote: “My surgeon said I have vocal nerve damage which is affecting my voice and my ability to drink liquids. I sometimes choke and can't cough anymore. Let's see it's been 2 weeks since my surgery. I go to see my surgeon in a few weeks.” Another said, “I had a total thyroidectomy two months ago…. I too choke on everything I drink and it is not improving. My voice is hoarse every morning and has no volume or pitch. If I try to raise my voice it only goes lower and feels like it is being choked off.”
These posts were from a decade ago, but I see the same problems discussed on Facebook support groups. These are tremendously active, with dozens of posts per day. I learned that there are many possible symptoms and that it is often a sort of fluke that people get diagnosed. There was also good advice as to what to ask the surgeon: How many Thyroidectomies a week do they do? (3 or more is what you want to hear). How big will the incision be? Will I have a drain? Who will call in the first thyroid hormone prescription. Will I spend the night? What is your complication rate? Have you ever cut anyone’s vocal cords? Will my vocal cords be monitored during the surgery?
There is often, as in my case, a decision to make: total or partial? On one hand, a person would wish to keep part of the thyroid if possible. The thyroid governs your metabolism. Says the Cleveland Clinic, “When your thyroid isn’t working properly, it can impact your entire body.” If the entire thyroid is removed, one has to replace the former natural hormones with synthetic ones and getting the dosage correct can be tricky. But with a partial thyroid removal, the remaining half of the gland can usually function. On the other hand, some people get a partial and then later cancer is found and the other half has to be removed anyhow. So medical personnel lean toward the TT (total thyroidectomy).
However, after reading about all the problems some people experience, I told my surgeon, Dr. Graves: “I’m not looking forward to this! I don’t need to be any more tired and depressed than I already am. I don’t need to be any more sensitive to cold than I already am. I don’t need to gain weight. I don’t need my hair to fall out!” Since these symptoms are much more likely with TT, I elected for partial.
. The advantage to a planned surgery as compared to an emergency is, of course, that one can prepare. There isn’t a great deal of preparation required for thyroid surgery, but a person who lives alone needs to think of everything in advance. I had to do some laundry, so I’d have clean sheets and clothes, as emphasized in the intensely detailed handout about showering three times with Chlorhexidine. I was sent home from my pre-op appointment with a bottle of the liquid soap.
I had several missed calls from someone whose accent was hard to understand in messages but who turned out to be quite delightful when we finally connected. This was a pre-op nurse named JoAnne. She went over the same instructions that I’d already received at my pre-op appointment, including no garlic from now until after surgery (like Vitamin C and aspirin, it can in large quantities keep blood from clotting). Someone named Katie called to verify the schedule with me, and reiterated the rules about nothing but clear liquids after midnight. Once the results from the second FNA came in, Tiffany, the NP in Dr. Graves’s office, called. Among other things, she advised me to lay in groceries, as I might feel too tired to shop for several days. So I went shopping, and in case I couldn’t eat regular food (the docs say you can eat the same day, but some patients post that they can hardly swallow for several days), I brought home yogurt, Ensure, instant mashed potatoes, soup, macaroni salad, and pudding. In some matters, I made adjustments. Posts on the thyroid surgery Facebook groups mentioned neck pillows for support. I figured a rolled up towel would do as well. They also mentioned ice packs for pain. I’ve read that a bag of frozen peas works, so I bought a couple of those—at least I’d have some vegetables around. Happily, I did not need iced peas for pain, but I did use the cough and throat drops I’d bought--Beekeepers Naturals (highly recommended, as they as soothing. We are advised to take Tylenol post-surgery, every six hours. I came across powdered Tylenol, which doesn’t even require water. It comes in individual packets and would be handy for travel, I think. We are also advised to take calcium afterwards, in the form of Tums, and I discovered Tums Smoothies, which virtually melt in your mouth. If there are children around, I’d be wary of keeping these forms of Tylenol and Tums around, as they are both quite tasty and could be mistaken for candy. Isn’t it odd that calcium carbonate (Tums) is good for indigestion? This form of calcium in fact, should be taken with food. On the other hand, calcium citrate is said to be better absorbed, but it should be taken alone.
Back to preparations: the chief challenge for someone living alone is arranging for someone to take one home afterwards. At least for this procedure, unlike the cataract surgeries I had five years ago, I was not required to have the same person bring me and stay and take me home—that had been a major hurdle when planning. Hospital protocols do not take into account the situation of people who live alone and don’t have friends or family nearby who can 1) drive, and 2) give up a chunk of time to take one to and from the hospital. Fortunately, one of my apartment neighbors works from home now agreed to pick me up. Of course, the time can’t be fixed in advance. Furthermore, there’s always that chance that the operation will turn into a TT, requiring an overnight stay.
A long period of retirement can lead to a sluggish and inefficient modus vivendi, so some tasks that might be routine to another person needed, in my case, to be written down in a detailed to-do list. These included ironing the clothes I planned to wear (they had been in the ironing basket for an extremely long time and were the wrinkly sort) and ensuring that I had quarters for the laundry (so I could have those clean sheets I was instructed to use after showering with the Chlorhexidine) and also cash for the bus Monday morning. Figuring that I’d have to remove my dentures before the surgery, I brought along one of the cute plastic denture containers the dentist had given me. Figuring also that I’d have to remove the full-length compression stocking I wear on my left leg for lymphedema, I brought one of my stretchy white knee-high stockings. (Note: These are intended to be understockings, but I have been using them “off label” as a nighttime garment.) I wrote my neighbor’s name and phone number on an index card and made sure I had my ID and vaccination card. The latter two were never requested, as it turned out: merely the usual name and birth date given orally. I guess the hospital figures it’s not very likely that someone would steal another person’s identity in order to have thyroid surgery….
My next worry was that I would oversleep, as I don’t normally get up early (see “sluggish” above) and I had to take my last Chlorhexidine shower in the morning. I set both my radio and my alarm clock, and took half a sleeping pill. Fortunately, Monday morning went smoothly. I dressed in some old black palazzo-style pants, a button-up flowered rayon shirt (in case I didn’t feel like lifting my arms afterward to pull anything over my head), and a loose, buttonless black cardigan, along with shoes that have a Velcro strap instead of laces (in case I was not supposed to bend over and tie my shoes afterwards). I had one last drink of water (as we can’t have any for at least two hours before surgery), and walked the four and a half blocks to the bus stop. It was a lovely day in May—I’d planned it this way, refusing to have surgery scheduled in the wintertime. I normally go to the medical center by a three-part route: bicycle, light rail, and shuttle, which is the most efficient way for me to get to certain locations. However, the hospital itself is visible from Stockton Blvd., so I was taking the bus this day. As it turned out, bus #38 stops well before the intersection or far past it, so when I disembarked I had to walk a couple of blocks back to the hospital. At one corner there was a sign asking the very good question “Peace when?” and two young ladies holding Watchtower magazines. “You look so elegant!” one exclaimed. The other added, “Your outfit is so flowing.” I paused long enough to joke that I was having surgery and surely the doctors take better care of patients who look stylish. The Jehovah’s Witness girls did not try to pray with me or hand me a pamphlet, thankfully, but their compliments were like a blessing.
At the hospital entrance, I grabbed a yellow mask from the dispenser (masks are still recommended there) and waited my turn. I had arrived at precisely my check-in time: 8:45. The receptionist gave me verbal directions, but a map would have helped. I know my way around the main floor—cafeteria, gift shop, exits—but now I had to reach the elevators, go to the second floor, and….then what? Luckily, a medical person happened along and gave me more directions. (I hope that at this point, you are saying “Wait! Why is the surgical outpatient unit so hard to find?” because that is what I myself was wondering.) After I checked in there (name and birth date, that is), I was led by a friendly woman named Annette to her station to have my vitals checked. I wish I could remember the names of all the staff I met that day, but at least I remember Annette. When she noted the height listed on my records, I protested, “I don’t know where they got five feet nine. I was five eleven-and-a-half all my life, and I may have lost height, but surely not that much!” She responded, “OK, let’s adjust it,” and she did!
Next I was taken to the pre-op room, which had five bays lining each side. The hospital provides bright green plastic bags in which to stash your clothing and other belongings; the bags are hung on a pole like a hat rack. The nurse and doctor agreed that my knee-high white stocking should be acceptable; for the surgery, they placed around my calves something called Intermittent Pneumatic Compression Devices to prevent blood clots. On the other hand, one is instructed not to take certain supplements as the surgery date approaches, as these (including vitamins E and plus garlic, ginger, and ginseng) may lead to excess blood loss. “The American Society of Anesthesiologists advises anyone planning to have surgery to stop taking all herbal supplements at least 2 to 3 weeks before surgery to rid the body of these substances.” (quoted on the Johns Hopkins website).
For the next hour or so, while waiting for the surgery time, I felt a bit like royalty receiving visits from my many subjects--except instead of bowing and offering gifts, they all asked me for my name and birth date, and if I knew why I was there. A nurse thoughtfully marked my neck on the right side (just in case the surgeons didn’t read their own instructions?). Well, one does hear of people having the wrong limb amputated, so it was a good idea. Of course, I had to sign more documents—sign, that is, by finger or by pen on a screen as one does now, never with an actual pen. I realized that I’ve not gotten around to finishing the Advance Directive forms I was given last year. Well, I just had to hope nothing bad happened for which my unspoken wishes would be needed. I was given the opportunity to use the toilet, and looked the other way while an IV port was installed into my arm (I’m quite squeamish). The anesthesiologist came by and I had a chance to express my concerns, which were about my clogged-up nose and chronic nasal drip. He assured me that the breathing tube down my throat would take care of that problem. (It does, but it is also partially to blame for the speaking, eating, and singing difficulties patients experience afterwards.)
At last it was time! An orderly pushed my gurney down various hallways; as I instinctively pulled in my feet whenever we rounded a corner, he commented that we were in the old part of the hospital. “Yes,” I said, “built back when people were shorter!”
The operating room seemed larger than the ORs on television. (There’s a good photo on another hospital website I came across:
https://www.stonybrookmedicine.edu/patientcare/PreSurgicalAdmissions/OperatingRoom)
Above me were big disks that if turned on would be clusters of bright lights. The friendly anesthesiologist placed a plastic device loosely over my nose and mouth, instructing me to take five deep breaths of oxygen. Then he instructed me to keep my eyes open as long as I could. Whatever they put into me was heavenly—lotus flower, perhaps! If only I could feel that happy and peaceful when I go to bed at night. (The clinic notes about my surgery online did not state what anesthetic was used, maybe so I wouldn’t be tempted to look for it on the black market!)
Well, that lovely state did not last long. Next thing I knew, I was awake in the post-op or recovery room; again I had the bay on the end. A nurse sat near me, doing some sort of work on a computer. I felt fine, but I had not brought anything to read. It was only 12:45 when I awoke—there was a big clock in my line of sight—so indeed, the surgery ad taken two hours; now the idea was to wait about four hours, and until a doctor released me. I dozed for a while, then decided to just observe what was going on—after all, this might be the very last time I would ever be in such a place!
The nurse fetched me water when I needed it. At one point I took down the green bag and got out my dentures and popped them in. Really, there was not much to observe. There was a large nurses’ station, but I couldn’t hear the discussions. On the other side of the curtain there was a man, and my nurse had to move her computer into the hall area so that she was watching over both of us. I got out my camera and took a few photos of my throat, as many patients post a post-op photo in the Facebook forums.
At last a doctor came along—one who had worked with Dr. Graves on the surgery—and said I was fine to go home. I wanted the nurse to call my friend, as I didn’t feel that I could speak very clearly (and mainly because I hate my cell phone). She took the index card and used her own cell phone to call. It turns out to be perfectly fine for your ride to be waiting in a car outside the entrance. An orderly or nursing assistant brought a wheelchair and helped me into it. She placed a pillow in my lap. I was confused and handed it back, as I didn’t know what to do with it. “You could take it home,” she explained. Oh, in that case, I wanted it—it had been a very comfortable pillow to lie on. But it was too late, as she had already put it into the trash bin. Lesson: Take your pillow home!
My neighbor was waiting, so soon I was home, with a great excuse to lie about watching television and eating eating all that soft food I had bought. An hour after I arrived home, I had a phone call from Dr. Graves, who apologized for not being able to see me before I left the hospital. She said that indeed, only the right side of the thyroid had to be removed, and she had been able to leave the parathyroids and lymph nodes alone—hurrah!
A day or two later, I realized that I’d better test out my voice. I could speak, but sure enough, my vocal range was truncated. Living alone, I often go whole days without speaking to another person, so I started talking more to myself—aloud, I mean, to loosen up my vocal cords. Other people can have the opposite problem. One woman said she can’t yell at her kids post-surgery, as her voice is so weakened. 😊 I normally have an alto type of singing voice, and my range is quite narrow, not much over an octave. At this time, I find (after looking up some nifty vocal range charts online) that I am in the middle of the bass range. In fact, I can sing only five notes: do re mi fa so—and then the la, ti, do are all on a level. One day I called a friend and moaned to her than I could not even sing an octave. As it turns out, my friend, though she loves classical music, claimed to have no idea what an octave is or whether one ought to be able to sing one, so I reminded her of the song in The Sound of Music. She was surprised to hear that I sing around the house, or walking down the street. And I have been surprised to learn that not everyone does so. I’m sure it’s technology’s fault—in the days before radio, TV, etc. etc, I believe people sang more. Anyhow, it’s now almost four weeks since the surgery and I can still only sing five notes. The only song I can sing is Mary Had a Little Lamb. I’ve copied the advice that other patents have posted (as provided by their speech or vocal therapists), and I’m going to look on You Tube. One fellow who posted on Facebook is an opera singer; he managed to perform again in only five months.
As for the scar, well, the younger women who post do have concerns about it. It’s not only ugly, it’s puffy. My surgeon advised massage, so I do that (lightly, of course), and one can use vitamin E to lessen the scarring.
So that is the story of a thyroid surgery. In case you ever have to have one, you can find good information online here:
https://www.mskcc.org/cancer-care/patient-education/about-your-thyroid-surgery
and here:
And don’t forget to take home your hospital pillow!
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