Survivorship: Health Concerns After Thyroidectomy
Hypothyroidism is a low level of thyroid hormone production. You can have hypothyroidism after partial or total removal of your thyroid. A medication called levothyroxine is used to replace thyroid hormones. After surgery to remove part or all of the thyroid, nearby lymph nodes or the parathyroid glands, you may need to take medicine (thyroid hormone) and vitamin and mineral supplements (vitamin D and calcium) for the rest of your life, to replace what is lost without these organs.
If you are taking levothyroxine, you will need to have your blood tested. The goal of the medication is to suppress thyroid stimulating hormone (TSH). Therefore, it is important to be monitored to be sure that the correct dose is being taken. By keeping TSH suppressed, the growth of any remaining thyroid cancer cells slows down, which lowers the chance of the cancer coming back (called recurrence).
Notes about levothyroxine:
- Should be taken in the morning 30-60 minutes before eating and with a full glass of water.
- Can interact with other medications or vitamins/supplements. You should talk to a pharmacist about any medications you are taking or starting.
- Avoid a high-fiber diet, soy-containing supplements, and walnuts as these can also interfere with how levothyroxine works.
- You may get a rash or lose some hair during the first months of treatment.
- Too much thyroid hormone (hyperthyroidism) may cause you to lose weight, become irritable, have sleep disturbances, changes in appetite, have more frequent than normal bowel movements, decreased menstrual flow, tremors, muscle weakness, and to feel hot and sweaty. It may also cause chest pain, cramps, and diarrhea.
- If the thyroid hormone level is too low (hypothyroidism), you may gain weight, feel tired, fatigued, depressed, have trouble concentrating, have hoarseness, joint pains, muscle cramps, constipation, changes in menstrual cycle, feel cold, have dry skin, or brittle hair.
- You should call your provider with any changes in how you are feeling.
Levothyroxine can cause problems for those with heart disease, clotting disorders, diabetes, and disorders of the adrenal or pituitary glands. Please be sure to tell your provider if you have or develop one of these conditions. Levothyroxine is safe to take while pregnant and breast feeding, but you may need to have blood work checked more often during this time.
Long Term Health Concerns
There are some long-term risks of continued TSH suppression. Leovthyroxine can affect the heart, causing atrial fibrillation (an irregular heartbeat) and an exacerbation of angina (chest pain) in patients with some types of heart disease. In addition, women may be at an increased risk for osteoporosis, especially those who are postmenopausal.
In some cases, certain nerves or muscles may be damaged or removed during surgery. If this happens, the patient may have voice changes, such as hoarseness or loss of voice, or one shoulder may hang lower than the other.
You may benefit from referral to an endocrinologist to manage thyroid levels, replacement treatment, and on-going care.
For those with complete removal of the thyroid (thyroidectomy), or those who have received radiation and/or I-131 therapy, hypoparathyroidism can also occur. Hypoparathyroidism is a result of damage to or removal of the parathyroid glands, which are located behind the thyroid gland. Loss of these glands results in a lack of parathyroid hormone. Parathyroid hormone regulates calcium and phosphorus in the blood.
Symptoms of hypoparathyroidism include numbness and tingling around the lips, or fingers and toes, muscle cramps or spasms. Management of hypoparathyroidism includes vitamin D and calcium supplements. You will have frequent blood tests to check your levels of calcium, phosphorus, and magnesium. An Electrocardiogram (ECG or EKG) may be done to check for arrhythmia (irregular heartbeat), which can be caused by low calcium levels and hypoparathyroidism. You may have a bone density test before starting treatment, which looks at the bones for osteoporosis and osteopenia.
Considerations for survivors of Medullary Thyroid Cancer
If you have been treated for medullary thyroid cancer (MTC) you should undergo genetic testing and counseling. Some cases of MTC result from a genetic abnormality or familial syndrome. Genetic testing can look for a mutation in the RET gene seen in familial MTC and MEN-2 (multiple endocrine neoplasia type 2) syndromes. People with MEN-2 syndromes are at increased risk for two specific tumors, pheochromocytoma and parathyroid adenoma. If a person has one of these mutations, it is very important that his/her family is also tested, including children and pre-teens. Almost all children and adults with these genetic mutations will develop MTC. For this reason, it is recommended that people with these mutations undergo a total thyroidectomy to prevent MTC from developing.
Survivors of MTC should also have additional blood work checked. Along with thyroid function tests and thyroglobulin levels, calcitonin and carcinoembryonic antigen (CEA) should be checked. If these levels begin to rise, a CT scan or MRI may be done to see if there is cancer recurrence.
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