Thyroid Surgery Recovery, Side Effects, and Complications

Thyroid surgery recovery time is different for everyone, but most people can go home the day after the procedure. It may take two weeks before you feel ready to go back to work after a thyroidectomy.

You will experience some pain after thyroid surgery, such as sore throat, neck pain, and difficulty swallowing. You'll need to follow a restricted diet until the day after surgery. And for the next few weeks, you'll have to avoid tasks that will put strain on your neck.

Side effects, such as neck pain and stiffness or sore throat, are common after surgery. Complications like hematoma and nerve injury are rare but can be serious and even potentially life-threatening if they do occur.

This article explores common side effects of thyroid surgery, what to expect during the recovery process, and warning signs of complications.

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Side Effects

There are a number of short-term side effects that people may experience after thyroid surgery. Most of these will be temporary, but some may persist.

Neck Pain and Stiffness

The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness.

Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.

Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours persists, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation (a physiatrist) or a physical therapist, They can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility.

A Sore Throat

Thyroid surgery is often done under general anesthesia with a breathing tube placed in the windpipe, or trachea, to breathe for you. This can lead to a sore throat and the sensation of a lump—like something is stuck in your throat—with swallowing.

Difficulty Swallowing

Dysphagia, or swallowing problems, are common after thyroid surgery, though they usually don't last long, often resolving within two weeks.

Hoarseness and Voice Problems

After surgery, your voice may be hoarse or whispery, and it may feel tiring to talk. This is very common and expected during the first week or two after surgery.

Around 1.6% of people may have permanent damage to the nerves supplying the vocal cords. Up to 11% of people will have temporary symptoms due to irritation of the nerves during surgery or inflammation around the nerves afterward.

Symptoms usually improve in the first few weeks but may persist up to six months after surgery. While there is no specific treatment for this hoarseness, it's helpful for your loved ones to be aware of the problem so that you don't feel the need to talk loudly or more often than is comfortable. If the nerve was injured, more severe symptoms may be noted after surgery.

Nausea or Vomiting

Nausea and vomiting after thyroidectomy was the norm at one time, and you may be concerned if you talk with others who had this procedure in the past.

Fortunately, if nausea does develop, there are treatments that can alleviate your symptoms. The use of medications such as dexamethasone can greatly reduce vomiting.

thyroidectomy side effects and complications
Verywell / Brianna Gilmartin

Transient Hypoparathyroidism

Transient (temporary) hypoparathyroidism can happen after thyroid surgery. Hypoparathyroidism occurs when you have too little parathyroid hormone, which can lead to low calcium levels.

The four parathyroid glands lie on the back of the thyroid gland and are sometimes injured or removed during surgery. These glands are responsible for controlling the body's calcium levels. They secrete parathyroid hormone that helps your kidneys and bones to maintain the balance of calcium and phosphorous.

More than half of those who get a total thyroidectomy may experience temporary low calcium levels, known as hypocalcemia, for at least a few weeks after thyroid surgery. It may last for up to six months.

Symptoms of hypocalcemia commonly include:

  • Numbness around the mouth
  • Tingling in the fingers
  • Muscle spasms or cramps

Most often calcium levels improve in a few weeks but may continue to be low for up to six months. During this time, your healthcare provider will monitor your calcium levels.

A 2018 study found that when a solution of potassium iodide was given prior to thyroid surgery for those with Grave's disease—a condition that can lead to an overactive thyroid—it was associated with less temporary hypoparathyroidism and hoarseness. It may also improve the safety of the procedure for those with Grave's disease. Consult with your surgeon about this prior to your surgery.

Hypothyroidism

If you have a total thyroidectomy or the entire thyroid gland is removed, you will require prescription thyroid replacement therapy after the procedure. This is because you'll no longer have a gland to make thyroid hormone and will experience symptoms of hypothyroidism, or an underactive thyroid, without replacement therapy.

If you have a subtotal thyroidectomy, which means all but a small portion of your thyroid is removed to try to preserve thyroid function, hypothyroidism sometimes still occurs and you will need monitoring to see if replacement therapy is needed.

If you had a subtotal thyroidectomy and are not immediately put on thyroid hormone medications, watch carefully for symptoms of hypothyroidism and contact your healthcare provider if they occur. Having regular thyroid testing done is also important, as hypothyroidism may not occur right away, or even for months or years.

There are many symptoms of hypothyroidism, but some of the more common ones include:

  • Feeling cold, especially in the extremities
  • Dry, coarse skin
  • Unexplained or excessive weight gain
  • Fatigue and sluggishness
  • Constipation
  • Muscle cramps
  • Increased menstrual flow and more frequent periods
  • Depression and difficulty concentrating
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Thyroidectomy Recovery Stories From 3 Different Patients

Complications

Though thyroid surgery is considered a relatively safe procedure, complications may sometimes occur. Some of these require prompt treatment, so it's important to be aware of them.

Hematoma

Bleeding into the tissues surrounding the neck, which is known as a neck hematoma, is uncommon, but is potentially life-threatening if not diagnosed and treated promptly. Occurring in roughly one in 300 procedures, most hematomas occur within 24 hours of surgery, though research indicates they may occur later in 10% to 28% of cases.

Symptoms may include an area of firmness and swelling on the front or side of the neck (usually beneath the incision), neck pain, and symptoms of airway obstruction such as shortness of breath, lightheadedness, or stridor (a high-pitched wheezing sound that's usually most noticeable with inspiration than exhalation).

Treatment includes immediate surgery to remove the hematoma and address any areas of bleeding.

Permanent Hypoparathyroidism

While temporary in some cases, hypoparathyroidism caused by the injury or removal of parathyroid glands can be permanent. As only one of the four parathyroid glands is needed to regulate calcium levels, the condition is uncommon, affecting roughly 2% of people who have a thyroidectomy.

Factors that increase the risk of hypoparathyroidism after thyroid surgery include a diagnosis of thyroid cancer, a longer duration of thyroid disease before surgery, a central incision, and the removal of a large amount of thyroid tissue.

If untreated and the condition is permanent, further symptoms may include tingling and numbness of the bottoms of the feet, muscle cramps and twitches, anxiety, depression, and headaches.

If hypocalcemia is severe, the condition can progress to symptoms of abnormal heart rhythms (arrhythmias), difficulty breathing (due to muscle spasms in the voice box), kidney stones, heart failure, and/or seizures. As with other side effects and complications, the timing of symptoms can vary from one person to the next.

Most often, lifelong calcium supplementation is all that is needed. But if severe symptoms occur, intravenous calcium, which is delivered in the hospital through a vein, may be required.

Laryngeal Nerve Injury

Less than 1% of people having a thyroidectomy will experience damage to either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve. If hoarseness persists, especially if it is still present six months after surgery, it's likely that the recurrent laryngeal nerve was injured. This nerve controls the muscles that move the vocal cords.

In addition to persistent hoarseness, injury to the recurrent laryngeal nerve may lead to other symptoms after surgery. These can include uncontrolled coughing when speaking, difficulty breathing, or the development of aspiration pneumonia—which is pneumonia caused by substances, such as from the mouth, getting into the lungs.

If any of these symptoms occur, immediate evaluation by a healthcare provider or an ear, nose, and throat (ENT) doctor is recommended. The ENT doctor will perform a procedure called a direct laryngoscopy to visualize the vocal cords and see if a tracheostomy, an incision in the neck for breathing, is needed. This is uncommon and primarily a concern if both nerves are damaged.

Injury to the external branch of the superior laryngeal nerve is usually less obvious. When injured, a person may have difficulty making high-pitched noises or yelling, though their routine speaking voice may be unchanged.

Infection

The risk of infection is present with any type of surgery but is relatively rare with thyroid surgery. It occurs in roughly one in 2,000 surgeries. Treatment usually includes IV antibiotics, which are medications to kill bacteria that are delivered through a vein.

Seroma

A seroma is a collection of fluid that can occur after many types of surgery. While the fluid is often reabsorbed by the body, large seromas may need to be drained.

Thyroid Storm

Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease.

Symptoms of thyroid storm include a fever (over 102 degrees F in most people), profuse sweating, a rapid heart rate, and sometimes delirium (severe confusion).

The use of iodine was thought to reduce the risk, but a 2017 study questioned the benefit. Treatment in the intensive care unit includes cooling, intravenous fluids, medications such as propylthiouracil (PTU), and management of arrhythmias.

Anesthesia Risks

Possible complications of general anesthesia may also occur since most thyroidectomies require it. This can include changes in blood pressure or heart problems.

Risk Factors

While complications can affect anyone, there are some risk factors that increase the chance of adverse effects. These include:

  • Being older than age 65
  • Smoking
  • The presence of other medical conditions, such as congestive heart failure or a bleeding disorder
  • Thyroid cancer, especially when a central neck dissection is done to remove lymph nodes
  • Repeat thyroid surgery

While a total thyroidectomy is a more extensive surgery than a subtotal thyroidectomy, several studies suggest that the safety of the two procedures is similar with regard to complications. However, temporary low calcium levels (and hypothyroidism due to the removal of the entire thyroid) are more common with the total procedure.

Inpatient vs. Outpatient

There has been some controversy over inpatient vs. outpatient thyroidectomies, especially with the recent trend toward same-day surgery. The primary reason for concern is that neck bleeding, which can be life-threatening, may occur after a person has returned home after outpatient surgery.

As far as safety, a 2018 study suggests that outpatient surgery may be safe, but the researchers admitted that the study may be biased. People who were at greater risk are more likely to be hospitalized, whereas those at lower risk were more likely to be offered the procedure on an outpatient basis.

Healthcare Provider Volume and Expertise

Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. Thus, it's a good idea to ask your surgeon how many thyroidectomies they have performed in the past.

You may also wish to ask about their complication rate, but this is not necessarily an accurate measure of competence. For example, more experienced surgeons may agree to take on more challenging cases that are likely to have a higher complication rate, and less experienced surgeons may limit themselves to low-risk cases.

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Recovery

After surgery, you will be monitored in the recovery room, sometimes for up to six hours. During this time, the staff will monitor you closely for any signs of neck swelling that could indicate a neck hematoma.

You may remain in the hospital overnight or be allowed to return home if you had outpatient surgery and are stable.

Before you leave the hospital, your healthcare provider will go over any instructions and talk about when you should follow up with your surgeon. Be sure you know what your at-home treatment regimen entails (medication, supplementation) and how to take any pain medications prescribed, if applicable.

Keep in mind that pain medications can cause constipation, and your healthcare provider may recommend a stool softener and/or laxative.

Once you are at home, raise the head of your bed to reduce swelling.

What to Eat After Surgery

You will be allowed to eat a regular diet once you return home, usually the day after surgery. Your surgeon will likely recommend avoiding heavy, fatty, or spicy foods for a few days.

Eating soft foods for the first few days can be helpful if your throat is sore or if swallowing is painful. Examples include foods with sauces or gravy, cooked vegetables, and casseroles.

Medications and Supplements

Your surgeon may send you home with medication or advise you to take certain supplements:

  • Pain medication: Most people do not experience excessive pain after thyroid surgery. You may need to take an over-the-counter pain medication such as Advil (ibuprofen) or Tylenol (acetaminophen).
  • Numbing throat spray: An over-the-counter (OTC) throat spray such as Chloraseptic, or numbing lozenges, such as Cepacol, can help with the discomfort of a sore throat.
  • Calcium and vitamin D: Since it's common for the parathyroid glands to function poorly after a thyroidectomy, you may be sent home with calcium and vitamin D supplements. When you have your follow-up appointment, your surgeon will check your blood calcium level.
  • Thyroid medication: Some people who undergo thyroid surgery may need to take a thyroid hormone replacement medication called Synthroid (levothyroxine). If your healthcare provider prescribes thyroid replacement therapy, be sure to have a conversation with them before leaving the hospital about when to start the medication, which medication you need, and at what dosage. It's also important to talk about how to properly take your medication, as food and many drugs and supplements can interfere with absorption.

Recuperation Time and Restrictions

Most people are advised to take roughly two weeks off from work to recuperate, depending on their occupation. You should not drive as long as you continue to need pain medications, and some surgeons recommend abstaining from driving for the first week after surgery altogether.

You should also avoid any heavy lifting or strenuous activities, such as many sports, for a few weeks. The excess activity could increase your chance of developing a hematoma or keep your wound from healing properly. Light housekeeping and walking are usually fine once you arrive home.

Stretching Exercises

Many surgeons recommend doing gentle stretching and range-of-motion exercises to reduce stiffness. Before doing these, however, ask your surgeon about their appropriateness for you, any additional exercises they believe might be helpful, how often you should perform them, and whether there are any exercises you should avoid. Recommended exercises may include the following:

  • Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
  • Gently tilt your head to the right and then to the left.
  • Rotate both shoulders forward in a circular motion.
  • Slowly raise your arms overhead, and then slowly lower them back down against your body.

Suggested frequency: 10 repetitions, three times a day.

Showering and Bathing

You can shower the day after surgery, but try to keep your neck as dry as possible while showering. Do not submerge, soak, or scrub your incision. After showering, you can lightly pat your neck dry or use a hair dryer set on the "cool" setting. Avoid swimming or taking baths for at least a week after the surgery.

Caring for Your Incision 

Your surgeon will talk to you about whether you should continue to wear a dressing over your incision.

If you had a drain placed, your surgeon will remove it the day after the surgery. You may have stitches that will need to be removed or absorbable sutures that will not. If Steri-Strips were applied, these will usually stay in place for around a week. Most surgeons recommend leaving these alone until they fall off by themselves, rather than trying to remove them.

Your incision may appear red and hard at first, and you may notice some slight swelling and bruising. If it itches, ask your surgeon if you can apply scar gel or aloe.

The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months. In time, your incision will turn pink and then white, and most are completely healed in six to nine months.

The University of California Los Angeles has a scar gallery with photos of people who have had thyroid surgery at various points in the healing process.

The area around your incision will be prone to sunburns, so wear sunscreen outdoors for at least a year after surgery.

When to See a Healthcare Provider

If you experience any of the following symptoms during your recovery, call your surgeon:

  • Fever and/or chills
  • Discharge from the incision
  • Signs of infection such as warmth around the incision, redness and swelling, or discomfort
  • Numbness and tingling around the lips, fingers, or toes

Seek emergency medical care at once if:

  • You are having trouble breathing.
  • Your voice becomes high-pitched.
  • You have worsening swelling in your neck.

Follow-Up

Generally speaking, you will usually need to return to the surgeon for a follow-up visit around one to two weeks after surgery. In the meantime, contact your thyroid-care team if you have any questions regarding your recovery process.

At your follow-up appointment, your surgeon will determine if you need to remain on calcium and vitamin D. If you were started on hormone replacement therapy, a thyroid-stimulating hormone test (TSH) should be checked about six weeks after surgery.

Thyroid Disease Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Summary

Side effects of thyroid surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism that usually resolves within a few weeks.

Complications are much less common and can include neck bleeding, permanent hypoparathyroidism that requires ongoing calcium replacement, and damage to nerves that can lead to long-term hoarseness and vocal changes.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 10th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2012.

Mary Shomon

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution."