Consultant Thyroid, Parathyroid, Hernia and Gallbladder Surgeon

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Advise from Consultant Surgeon Mr James Kirkby-Bott

Medications Post Endocrine Surgery


Pain Relief

Everyone is sent home after surgery with pain relief. Some people don’t feel they need it, and some do. Take it as you need to, but follow this advice for the best results:


Paracetamol
Take paracetamol regularly four times a day until you aren’t taking anything else and then start to take it as you need to until you no longer need it. In the prescribed dose it has no side effects and is the most effective painkiller on the market.
 
Ibuprofen
If more pain relief is needed, take some Ibuprofen in addition to the paracetamol. Take it up to three times a day with some food or a nutritious drink. This drug has some interactions with other health problems but taken in the prescribed amount for a just a few days is generally very safe with few side effects, even if you have been told not to take this in the past. You can ask for advice about whether to take this if you feel uncertain.
 
Dihydrocodeine
Lastly, you will go home with Dihydrocodeine. This painkiller is really strong and if taken when not really needed will cause sleepiness and can cause headaches. It also causes constipation, so make sure your bowel habit is regular (aim for once day). Use a laxative if you need to use this drug and it is causing constipation. Only take this as required. Add it to the paracetamol and Ibuprofen that you should already be taking.

Thyroid hormone replacement

If you have had a total thyroidectomy or a completion thyroidectomy to remove the rest of your thyroid gland at a second operation, you will need thyroxine every day for life.
Take it first thing in the morning at least 20 minutes before any tea/coffee or breakfast and any other medication you take in the morning. It has few if any side effects despite what any internet searches will show. However, it is important to follow the instructions on avoiding other foods/drinks or medication at the same time as this tablet.
The dose sometimes needs altering to make you feel normal. If you take it regularly and miss it for a week no harm will come, but if you stop taking it longer than this or irregularly then problems and slowness and feeling unwell will occur. It is simple to take, but important to take correctly.
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Calcium replacement

If you have had a total thyroidectomy or a completion thyroidectomy to remove the rest of your thyroid gland at a second operation, you are at risk of developing a low blood calcium after your surgery.

This is due to 4 very small glands adherent to your thyroid being temporarily (or infrequently permanently) disrupted by dissecting them off the thyroid gland at your operation. They have an important role controlling your calcium levels, and if they stop working you can experience a tingling sensation around your lips and fingertips.

If this is left untreated, you can then get cramps and muscle weakness. If left completely untreated it can adversely affect how your heart beats. If you treat it at the first signs of tingling these more dangerous effects will be avoided.

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How to Manage Symptoms of a Low Calcium


Even without symptoms, you should take a vitamin D tablet every morning with breakfast. This will help reduce the severity of any symptoms you might develop.
 
If you are getting symptoms, take the calcium tablets you have been sent home with.
These will either be a chewable sweet or a tablet that dissolves in water to be drunk. Take the calcium tablet as often as you need to make the tingling sensations go away. If you are taking a lot of calcichew, they can cause constipation.
 
If despite taking these tablets you develop uncontrollable symptoms, please seek medical advice and help.
 
Over 90% of patients that suffer from low calcium find it lasts less than a few months.
In most cases low calcium lasts a week or two as bruising around the parathyroid glands resolves and they start to work normally again. 
In <1% the symptoms are permanent. If this happens, the severity usually subsides and symptoms can be managed by taking calcium tablets regularly twice a day.
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