Apple ENT Care Nursing Home
Surgical Service, ENT Section
Patient Postoperative Instructions and
thyroid gland is in the front lower part of your neck. It makes hormones
that help make your body work right. Your thyroid gland has
2 sections. Each section has parathyroid glands.
Thyroid nodules (round hard lump
of cells) are common. If a nodule has cancer in it, then the half of the
thyroid gland with the nodule must be taken out. The surgery is needed to find
out if it is cancer. If you have cancer, your thyroid gland, as well as tissue
and lymph nodes around the gland may be
taken out. Some people have a big thyroid that causes problems
swallowing or breathing. This is called a goiter and is not cancer.
If you have a goiter you may
need surgery to take it out.
surgeon makes an incision (cut) in the lower area of your neck. The exact size
of the cut varies, so you may ask your surgeon to show you. The surgeon then carefully cuts out the
thyroid lobe(s.) Your surgeon will find your vocal cord nerve and work around
it. There are tiny glands called parathyroid glands that are carefully cut away
from the gland and left in the neck. If your whole thyroid needs to be taken
out, the same process is carried out on the other side.
vocal cord is usually not harmed by the surgery. Your voice may be hoarse or
weak after surgery. Only 10-30% will be hoarse after surgery. Less than 5% will always be hoarse after the
surgery. We will check your vocal cords at your post-operative visit so try not
to worry about it until then.
Your parathyroid glands may not work as well as they should
after surgery. This can cause your calcium blood levels to drop too low. This
can be life-threatening. This may be a
problem for a short time, or it may be long lasting. Up to 30% of patients will
have problems with their parathyroid glands.
It is rare to have long lasting problems with your parathyroid.
you have just one half of your thyroid removed (thyroid lobectomy, or
hemithyroidectomy) then you may go home the same day of surgery. You will need
someone to drive you home. You will stay
in the hospital at least 1 night if you had to have your whole thyroid taken
out (total thyroidectomy). Your blood calcium levels will be checked every 6
hours. If they are stable, you can go home the next day. If they are too low,
we will have to give you calcium and vitamin D until your levels become stable.
This may take 2-3 days, rarely more.
you have had your whole thyroid taken out, you will have to take a thyroid
hormone pill every day for the rest of your life. The exact dose of the med may
need to be adjusted over time. We will ask your primary care doctor or
endocrinologist (a doctor that treats diseases that affect your glands) to
check blood tests 6 weeks after starting your thyroid hormone. Your dose of the
thyroid hormone med will be adjusted as needed. Sometimes, your endocrinologist
does not want you to start taking this hormone until the tests come back
showing you do not have cancer. Your surgeon will let you know.
should be called by your surgeon as soon as the lab doctor looks at your
thyroid for cancer.
can take 5-7 business days or more. Please
call if you have not heard the results and it has been 7 VA business days since
keep the incision dry for 3 days, and then you may shower and pat the incision
dry. You may use Q-tips or gauze dipped in a ½ hydrogen peroxide and ½ water
mixture to remove any dried blood over the incision. After washing, apply a
thin film of an antibacterial ointment such as Polysporin. Apply the ointment 2
times a day. However, if your surgeon used
skin glue you may shower right away, and you do not need to use antibiotic
ointment. The skin glue will slowly peel off after 1-2 weeks. If it has not all
come off by your postoperative appointment, we will remove it at that time.
avoid any activity that pulls across the incision, such as shaving, for at
least 2 weeks. The rest of the face may be shaved. The staples and/or stitches
will be taken out 1-2 weeks after surgery at your postoperative appointment in
the Ear Nose Throat (ENT) clinic.
patients go home with a thin drain tube and an egg shaped collecting bulb
called a JP drain. The tube should be gently stripped every 4 hours. A nurse
will teach you how to do this before you leave the hospital. When the JP drain
looks half full or at least 2 times a day, please empty the bulb into a small
plastic measuring cup. Then write down the amount in the cup. Pour the fluid in
the sink or toilet. When the amount of fluid emptied from the drain is 30 ml
(or 2 tablespoons) or less in a 24-hour period, the drain is ready to be taken
out. If the drain is in place for 1 week it needs to be taken out no matter how
much fluid drained. Call the ENT clinic to have the drain taken out. If it is a
weekend or holiday, call the ENT resident doctor on call to have the drain
fluid from the JP drain should be red, pink, or straw colored (yellow.) If it
is milky or looks like pus, you need to be seen by your surgeon right away.
raise the head of your bed 30-45 degrees or sleep in a recliner for the first
3-4 days to decrease swelling. The skin above the incision may look swollen
after lying down for a few hours.
straining, heavy lifting, or vigorous exercise for 2 weeks after surgery.
may eat your regular diet after surgery.
Your pain can be mild to
moderate the first 24 – 48 hours. The pain usually lessens after that. Many
patients complain more about a sore throat from the breathing tube used during
surgery then about pain from the surgery itself. Your pain will get better in
1-2 days and is best treated with throat lozenges.
may not need strong narcotic pain medication. The sooner you reduce your
narcotic pain medication use, the faster you will heal. As your pain lessens,
try using extra-strength acetaminophen (Tylenol) instead of your narcotic med.
It is best to reduce your pain to a level you can manage, rather than to get
rid of the pain completely. Please start
at a lower of narcotic pain med, and increase the dose only if the pain remains
uncontrolled. Decrease the dose if the side effects are too severe.
Do not drive, operate dangerous
machinery, or do anything dangerous if you are taking narcotic pain medication
(such as oxycodone, hydrocodone, morphine, etc.) This medication affects your
reflexes and responses, just like alcohol.
When to Call Your Surgeon: If you have…
Any concerns. We would much rather that
you call your surgeon then worry at home, or get into trouble.
Any numbness or tingling around your
mouth, in your fingers or toes, or anywhere. This may be a sign of low blood
calcium levels. If you have muscle cramping and or curling of your fingers or
toes, this could be even more seriously low blood calcium levels. THIS CAN BE A
LIFE-THREATENING PROBLEM. You must go
have your blood calcium levels drawn immediately. You should not drive if
you are having these symptoms. You need to have someone drive you to the
nearest VA Emergency Room (ER), if possible. If you live too far away, go to a
nearby ER. Have the ER staff call your VA surgeon after drawing your blood
calcium and giving you extra calcium if needed. Bring these postoperative
instructions with you to show to them. If your blood calcium gets too low,
you could have seizures or your heart could stop, so you must take this
Fever over 101.5 degrees F.
Foul smelling discharge from your
Large amount of bleeding.
More than expected swelling of your
Increase warmth or redness around the
Pain that continues to increase instead
or coughing with food or liquid.
How to Call Your Surgeon:
- If it is urgent, call 911 or go directly to the emergency room
- If it is not urgent, during clinic hours of 8 am to 4 pm, call
ENT secretary at 352-548-6143 or the ENT clinical coordinator at
352-548-6142. Messages will be checked frequently and a doctor will be
asked to return your call.
- If it is not urgent but cannot wait 2 hours, please try a number
of ENT clinic numbers: nurses’ station at 352-548-6150 or the front desk
at 352-548-6153. Do not leave a message at these numbers.
- If you still have not spoken with a surgeon, or if it is after 4
pm or a weekend, call the VA operator at 352-376-1611(toll free
1-800-324-8387) and press 0 to speak with the operator. Insist that the
operator page the ENT resident surgeon on-call.
If you have stitches, you will need to have them taken out
at your postoperative visit 7-10 days after surgery. If you have skin glue, you
need to be seen about 2-3 weeks after surgery. If this appointment has not been
made for you, please call the ENT front desk at 3