Thyroid surgery

There are several reasons that thyroid surgery is performed and they can include:

• Symptomatic thyroid nodules
• Recurrent thyroid cysts
• Goiter
• Graves' Disease
• To rule out or treat thyroid cancer.

Risks

There are risks involved with any surgical procedure. The risk of infection is so low that antibiotics are not routinely used. with the average blood loss being less than an ounce, it makes the risk of bleeding very low.

There are very important nerves in the neck called recurrent laryngeal nerves, and there is a low risk of these nerves being injured during surgery. These nerves control the vocal cords and injury to these nerves could affect your child's voice.

The parathyroid glands are located near the thyroid gland and may be injured during thyroid surgery. This can result in a drop in blood calcium levels. There is also a small risk associated with anesthesia. However, the relative risk of complications is very low and is usually outweighed by the potential benefits of having the surgery.

If you have any concerns or questions about your child's surgery, be sure to discuss them with your child's surgeon, before the surgery.

During surgery

Your child will be given general anesthesia to put him or her to sleep. Your child is positioned with special pillows under his or her neck to tilt their head back. An incision is made at the base of your child's neck and is about three to four inches long. Using magnifying lenses, the surgeon locates the thyroid gland and associated structures and all or part of the thyroid is removed. In some cases additional surgery will involve removal of lymph nodes and other structures. The incision is stitched closed and is then covered with steristrip tapes and a dry gauze dressing. The operation generally lasts from two to three hours. After surgery, your child will stay in the recovery room for several hours. He or she will be monitored closely as they recover from the anesthesia.

After surgery

The evening after surgery your child will have a liquid diet for dinner. He or she may have a sore throat. The nurse will provide lozenges and/or throat spray to help relieve this. If your child needs something for pain, the nurse will give him or her a liquid pain medicine. Your child will have a dressing on their neck which will be removed in the morning. The head of their bed will be raised to decrease swelling. They will have an intravenous line to give them fluids until the next day. Your child will have routine blood tests. They will be offered regular food the next morning. Most children are ready to go home after breakfast.

The incision

Once the dressing is removed, you will notice that the incision is covered with tapes (steri-strips). These will stay on for about a week. Leave the steri-strips in place. Your child may shower the day after surgery. Try to keep the neck area as dry as possible and pat dry after he or she showers. Your child's stitches will be removed in the office about a week and a half after surgery. Infection is extremely rare. If you notice any redness or drainage from the incision contact your child's surgeon. After the stitches are removed, the most important thing you can do to improve the appearance of your child's scar is to protect it with sunscreen that has a sun protection factor (SPF) of 30 for an entire year. During the year your child's scar may become raised or red, but will almost always fade into a thin line which will be less noticeable.

How will My child feel after surgery?

Everyone is different. Your child will most likely be tired and a bit sore for a few days. He or she may have pain not only from their incision, but also from muscle soreness in their upper back and shoulders. This is from the positioning in the operating room during the surgery. He or she will have liquid pain medicine in the hospital and a prescription for pain medication at home.

Your child may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help. Your child's neck may be slightly swollen as well. they may feel like they have a lump in their throat when they swallow. This will improve after a few days but may continue for a week or so. If you notice sudden swelling in your child's neck contact your child's surgeon's office. Your child's calcium level may drop after surgery. This is related to disturbance of the parathyroid gland, which regulate calcium balance. This will be monitored through blood tests. Your child may notice numbness and tingling of their fingers or around their mouth. You will have instructions about giving your child calcium replacement if needed.

Recovering at Home

Most children need to take 1 to 2 weeks off to recover. Depending on the amount of thyroid tissue that was removed and the reason for his or her surgery, They may be placed on thyroid hormone (Synthroid or Cytomel). Your child's doctor will discuss their situation with you.

Radioactive Iodine

How does Radioactive Iodine Treatment Work?

The thyroid actively accumulates iodine, which it uses to produce thyroid hormones required for normal body function. This RAI is like the iodine found in foods such as fish, seaweed, and iodized salt, except that it releases an electron, or beta particle, which creates its therapeutic action.

How is Radioactive Iodine given?

RAI is given dissolved in water or as a capsule. It is quickly absorbed by the stomach and intestines, then it is carried in the bloodstream to the thyroid, where it is taken up by the gland.

Once in the thyroid gland, the RAI disrupts the function of some of the thyroid cells. The more radioactive iodine that's given, the more cells cease to function.

Side Effects

There are few side effects from Radioactive Iodine,. A sore throat may occur a few days after the treatment, and this can be treated with acetaminophen. Sometimes, the salivary glands may swell, which is caused by the iodine and not the radioactivity. Some doctors believe that sucking on hard candies for a few days can prevent this. Nausea may develop for a few hours after the iodine is taken, so it is best that you do not eat two hours before or after the iodine administration.

Precautions

a small amount of radiation emanates from the neck where the RAI is stored for a few days after treatment. Although this radiation is beneficial for the person being treated, precautions are needed to reduce the radiation families and friends are exposed to. These precautions include:

• Avoid prolonged contact with others, especially children and pregnant women.



A distance of one arm's length should be maintained between the person treated and others who spend more than two hours next to the person treated in any 24 hour period. This applies especially to children and pregnant women. While brief contact with a person after treatment is acceptable, sleeping together, watching television, going to movies, long care or plane trips should be avoided for approximately 11 days after the treatment.

Sharing eating utensils, or glasses should be avoided. Do not eat or drink after the person who received the RAI treatment. Wash the cups, plates and utensils of the person who received the treatment separately. Cooking is fine, as long as the person who was treated with RAI is not tasting the food while it is being prepared.

• Drink lots of liquids, void often, and flush twice.



The treated person should drink lots of fluids especially water, this helps remove the RAI from the system. Flush the toilet twice after using it, and be sure to thoroughly clean up any spilled urine.

After The Treatment

Symptoms of the disease will begin to improve about 2 weeks after the treatment. Muscle strength improves, tremors and irritability lessen, heat intolerance improves, and sleep is more sound.

The person who had the treatment will now have an underactive thyroid. A single daily pill of thyroid hormone, T4, must be taken for life. Anyone treated with RAI will need to have their levels tested to make sure they are getting the right amount of thyroid hormone, so they must remain under the care of their doctor indefinitely.

On April 21, 2009, my daughter Kayla had her thyroid removed. This is in no way a recommendation for choosing surgery over RAI. Surgery was the best choice for Kayla. RAI, might be the best choice for another family, which is why I am giving information on both. I only want parents to find the information that they will need to make the best choice for their child. Unfortunately, I know for many parents choosing between surgery and RAI will be a descision they will have to make and no matter what you decide, our prayers go with you.