An Exhaustive Account of my Thyroidectomy Experience

I've labeled each section to make it easier for the reader to skip any parts that may be irrelevant/ uninteresting to them.

History

I was diagnosed with Grave's disease back in 2013. The symptoms I experienced included rapid/irregular heartbeat, fatigue, heat intolerance, stomach pain, diarrhea every single day, mental fog, confusion, a quick temper, and forgetfulness. My goiter ended up being around 7 cm by the time it was taken out. My creative drive had all but disappeared, and it was a feat to do the simplest things around the house. I just wanted to lay under a fan and watch TV. My entire twenties were lost to this shit disease, and I couldn't manage to get the surgery working multiple part-time jobs in a state that expects low income people to rot and reproduce. It's time, experiences, and even jobs that I'll never get back.

Anyways, I finally got a decent endo and was referred to an excellent ENT surgeon. My endo really wanted me to do RAI, but after reading all the research I could find on patient experiences in surgery versus RAI, surgery seemed like the obvious choice to me, especially since RAI couldn't guarantee a reduction in the size of my goiter. My neck was so large, I couldn't see or even feel the ends of my clavicle. Of course, this made me very self-conscious.

After hesitantly agreeing to RAI and changing my mind a few days beforehand, I had a consult with my surgeon. I asked him whether he took out a lot of post RAI thyroids, and he confirmed that he had. He also mentioned that it is way more difficult than taking it out straight away, as the degraded tissue "sticks" to everything around it. He also informed me that my thyroid had grown past my collar bone at this point. I scheduled the surgery only a few weeks out from my first consult.

**Speech Pathologist Testing**

Between then and the surgery, I had a pre-op (painless) as well as a consult with a speech pathologist. My ENT surgeon recommended this, as I had mentioned having trouble swallowing food and pills. He also wanted her to check out my vocal chords due to the size of my goiter. I don't believe most patients who don't experience these symptoms have to do the speech battery, which is fortunate as it was honestly one of the most uncomfortable points of the entire process. The pathologist put a scope down my nasal cavity all the way down to my vocal chords. We could not use local anesthetic, as this would affect my speech. With the scope still down my esophagus, another staffer fed me muffins, cookies, pudding, and water several times while the pathologist observed via scope. Doesn't sound too bad on paper, but it was awful to do with a metal rod down my nose. I had tears streaming down my eyes the entire time. This procedure probably lasted about 20-30 minutes, though it felt like an eternity. I had no pain after the procedure was done.

Surgery

I had one more consult with my ENT before showing up at the hospital the day of surgery. Once I arrived, I was given a gown and socks, removed jewelry, standard stuff. They also put what looked like blood pressure cuffs on my legs to prevent blood clots. I was visited by a nurse who installed an IV on the top of my hand, as well as the anesthesiologist and ENT for any last-minute questions. I believe the procedure lasted about 4 hours. The surgeon mentioned that it was one of the more challenging thyroidectomies he's done after >600 of them due to its size and inflammation. He also mentioned that he was concerned once he got in that I would go into a thyroid storm due to the inflammation and bleeding, but fortunately that did not occur. In addition to the sealed incision, there were two Jackson-Pratt drains installed beneath my collar via surgical glue (no stitches).

I know that every hospital is going to have a different policy right now regarding COVID-19 measures, but I was allowed one visitor in the waiting room who could stay with me. I brought my mother.

Recovery: My Super Happy Funtimes Anesthesia Experience

I woke up back in their recovery room before being taken to my room. I actually felt pretty dang good up until that evening, when I had I bad reaction to the anesthesia and started throwing up, which lasted all night and into the wee hours of the morning. The nurses administered something for nausea via my IV (I'm sorry I can't recall the name). If it helped at all, I couldn't tell any difference. I later found out that my grandmother also reacts the same way to anesthesia. By this point, my neck was black with bruising, and every retch made me feel like my incision was going to explode into a not-so-radical death metal album cover. I was really glad to have my mother there to run about and bring more barf bags, as I could hardly make it to the bathroom. I would probably rate this as the second most painful point of the entire experience, which hopefully any readers of this are able to bypass. After the first night, I did not experience any further nausea. My surgeon said that he was glad I didn't pop off any of the clips in my neck during this time.

Recovery: Phelgm!

While I was still under anesthesia, my ENT put another camera scope down my esophagus to ensure there wasn't any trauma to my vocal chords. This broke up a BUNCH of phlegm in my throat, and I started coughing up gobs of it in the night. It was very difficult to cough up due to the several bruising and trauma I still had to my throat, and I started having a panic attack after a few hours of struggling to breathe. This was the only point at which I took any pain killer other than Tylenol, after I reported my pain at a 7. The phelgm itself obviously wasn't that painful, but the pain in my neck was so severe that I was afraid I wouldn't be able to expel it and choke in my sleep. I'm sure that this wasn't helped by the fact that I had vomited my guts up the night prior. My neck was just so sore, and I was exhausted at this point. The nurse administered fentanyl via my IV and brought me Robitussin. The fentanyl was a total life saver; it relaxed me and my breathing quickly enough to get some sleep. I continued to take Robitussin for the next day and a half until I felt okay enough to stop. This also helped me sleep after a day and a half of being up all night.

Recovery: Calcium Drop

I would have been sent home earlier, but they ended up having trouble getting my calcium levels up, which my ENT had anticipated prior (though perhaps not to this extent). It was explained that he managed to retain at least three of my parathyroid glands, which regulate calcium, but that they had gone into "shock" after surgery and would take some time to "wake up". The pathology report later indicated that only one gland had been removed during surgery. My ENT told me that that meant I had one or more still under my collar, which he says will not have any adverse effect other than taking calcium supplements permanently. I mostly bided my time at this point until I woke up one morning unable to move my face, and with tingling in my hands and feet. This turned out to be due to a severe calcium drop which was resolved by administering calcium via my IV, but it was still a pretty scary experience. Afterwards, and endo was called in to access me and started to prescribe high doses of calcium until it was manageable enough for me to be released. My ENT mentioned that it was only the second time he'd had to call in assistance with this.

Recovery: Drains

At this point, the nurses removed my drains and sent me on my way. I understand that most will go home with them and come back for removal. I just popped the bulbs into the gown or a jacket while I wore them. They were a bit of a pain to manage while I was sponge bathing, but I set them into the gap between the wall and a handrail, no biggie. The drains were incredibly painful to be removed, but the pain lasted for the 2 seconds it took for them to be yanked out, and then quickly subsided. As I mentioned, I had two drains installed due to the size of my goiter, but I was told that most only end up having one. Frankly, I felt the pain had been exaggerated a bit compared to the brevity, but it's better to be prepared then caught off guard! I asked to take Tylenol beforehand, but either way, just mentally prepare yourself and don't let yourself hype it up too much. You'll be okay, really!

Recovery: At Home

All in all, I ended up staying in the hospital for 4 nights and one day. I'm now 8 days out from my surgery, and I honestly feel great! My scar and drain scars have been healing great. I haven't been using anything on them since I had a severe reaction to Aquaphor and Bacterin ( no surprise there- I break out just looking at scented hand soap), but they've been healing just fine without them. My mind feels like it's starting to clear, and I have so much more energy than I used to. I've been taking synthoid, magnesium, and calcium supplements at home. I'm going in next week for my followup with my ENT and endo- hoping for a good report! I'll update a little further out, too.

I'm sorry that this ended up being so damn long, but I really wanted to lay everything out for those who might be questioning or unsure, like I was before. Obviously, there are a lot of weird factors/reactions that are probably pretty unique to my experience, but I still wanted to include them. I felt it pretty remarkable that I only took painkillers stronger than Tylenol once throughout the entire process. Not bad, in my book! Please let me know if you have any questions, and I'll try to answer them to the best of my ability. Thank you for reading!!

TLDR; I had a total thyroidectomy; experienced some pain/discomfort at a minimal-average level; I'm happy with my choice and would choose it again over RAI.