Laryngeal nerve damage and hypoparathyroidism are only part of the likely consequences of thyroid gland removal in women. After a total thyroidectomy, the life of patients changes dramatically. Excision of the organ leads to a sharp decrease in thyroid hormones in the blood. They affect the functioning of the endocrine, nervous, digestive, reproductive and other systems. To maintain homeostasis, women need to take substitutes for the missing hormones throughout their lives .   

When is total thyroidectomy necessary ?

According to many endocrinologist surgeons, complete removal of the thyroid gland is not always justified. Total thyroidectomy is fraught with complications, some of which arise through the fault of the operated women. Surgical intervention is recommended for patients with thyroid diseases if drug therapy is ineffective .     

According to statistics, women are 17 times more likely to undergo surgery than men. Sometimes organ removal becomes the only way to combat infertility. Total thyroidectomy is prescribed for women with:

• endemic goiter;
• adenoma of the thyroid gland; 
• Graves’ disease;
• myxedema;
• decompensated thyrotoxicosis;
• malignant tumors in the thyroid lobes; 
• infertility on the background of thyrotoxicosis;
• postpartum thyroiditis ;
• resistance of the thyroid gland to hormonal drugs;
• intolerance to thyrostatic drugs;
• the risk of malignancy of the organ due to the deposition of calcium salts in it. 

Methods for removing the thyroid lobes, the scope of the operation depend on the nature of the disease. In 97% of cases, total thyroidectomy is prescribed for women with malignant neoplasms.

Hormone-dependent tumors in the area of ​​the thyroid lobes in 35-50% of cases become the reason for radical surgery. An increase in the size of neoplasms often leads to a displacement of the trachea, esophagus. This is fraught with respiratory failure in women and even suffocation.  

The consequences of removing the thyroid gland in women

To find out what threatens women with thyroidectomy , you should consider the possible consequences of the operation. They are conventionally divided into 2 categories:  

• Early – complications that occur in women immediately after surgery. They are caused by damage to the vagus nerve, parathyroid gland, blood vessels, etc. 
• Late – delayed complications caused by changes in hormonal levels. More than 50% of them appear due to the untimely intake of substitutes for thyroid hormones by women.

The success of thyroidectomy depends on the skill of the surgeon and the woman’s compliance with hormone replacement therapy (HRT).

Early postoperative period

The neck is a difficult anatomical zone, in which there is a network of blood vessels, multiple nerve bundles and glands – parathyroid, thyroid. Even an experienced surgeon is not always able to perform the operation perfectly. Thyroidectomy is complicated by an increase in the size of the thyroid lobes, the formation of cysts or tumors on them .    

Up to 63% of complications appear due to the anatomically low location of the thyroid lobes, overweight patients.

In about 2% of cases, removal of the thyroid lobe is accompanied by damage to closely spaced anatomical structures. Possible early postoperative complications of the operation include:   

• Damage to the parathyroid glands. On the back of the thyroid gland there are 4 glandular seals that produce parathyroid hormones. Their damage leads to dysfunction of the parathyroid glands. Because of this, women experience complications in the form of painful cramps, excessive sweating, insomnia, and impaired digestion. 
• Postoperative bleeding. Accidental dissection of large arteries is fraught with massive blood loss, which are dangerous hemorrhagic shock.  
• Posthemorrhagic anemia. Due to severe blood loss, women are diagnosed with anemia. It is manifested by fatigue, dizziness, deterioration of the skin condition, loss of strength, pallor.
• Nerve damage. More than 70% of early postoperative complications in women result from dissection of the recurrent nerve. It runs in the area of ​​the right and left thyroid lobes. Accidental damage to the nerve leads to a violation of the swallowing reflex, speech, and sometimes breathing.

The greatest danger to women’s health is damage to the parathyroid gland and recurrent nerve. Such patients should be constantly monitored by a doctor, to take tests for the content of parathyroid hormones.

Long-term consequences

Delayed complications are caused by a deficiency of iodine-containing hormones. In women, the same hormonal disturbances occur as in hypothyroidism.  

Women tolerate the consequences of total removal of the thyroid lobes worse. The hormonal deficiency caused by the operation leads to serious disorders in the reproductive system.

The long-term consequences of thyroidectomy in women include:

• decreased performance;
• cold intolerance;
• swelling of the face and limbs; 
• violation of the heart rhythm;
• emotional lability;
• depressive conditions;
• dry skin;
• slowing down the metabolism;
• lowering body temperature;
• decreased intelligence;
• weight gain;
• Iron-deficiency anemia;
• insufficiency of blood circulation;
• moderate muscle weakness;
• decreased appetite.

In 89% of women, hyperprolactinemic hypogonadism syndrome is manifested . In connection with the dysfunction of the ovaries, the following complications appear:

• profuse menstruation;
• violation of the menstrual cycle;
• secondary amenorrhea, or absence of menstruation.

The most dangerous delayed complication is hypothyroid coma. It occurs when women do not take iodine-containing hormone substitutes on time. It is accompanied by an increase in symptoms, therefore, for 40% of women it is fatal. 

Life after removal of the thyroid gland in women

Subject to the rules of surgical intervention, the risk of postoperative complications is low. Life without a thyroid gland in 90% of cases does not require drastic changes. But in order to compensate for the lack of iodine-containing hormones in the body, women must adhere to a diet, take hormone replacement drugs.  

Disability after resection of the thyroid lobes is usually not prescribed. With the observance of drug therapy, 96% of women return to working capacity in full. 

Diet and exercise

Operated women should review their diet. By removing the thyroid lobes, metabolism and catabolism are slowed down, which is fraught with rapid weight gain. To prevent complications, patients should follow a salt-free, low-calorie diet.

The main postulates of the dietary program: 

• fractional meals in small portions – up to 6 meals weighing up to 300 g;
• compliance with the energy volume – the amount of calories consumed should correspond to the amount of energy that was consumed;
• heat treatment – steamed dishes are preferred to fried foods.

Dosed physical activity helps to restore the endocrine system. Moderate exercise is recommended for women with thyroid gland removed – swimming, cycling, fitness, walking. To avoid complications, one should abandon traumatic sports, team games.

Dispensary registration

The total removal of the thyroid lobes is the basis for registering women at the endocrinological dispensary. Under the supervision of an endocrinologist, patients receive:  

• qualified outpatient care;
• planned examination and rehabilitation;
• recommendations for a healthy lifestyle;
• consultations in difficult clinical cases.

Depending on the plan drawn up by a specialist, women undergo preventive treatment for endocrine diseases.

Substitution therapy

Taking hormones is an integral part of the life of all patients with a removed thyroid gland. To achieve a physiological concentration of iodine-containing hormones, the following drugs are prescribed:    

• L-thyroxine is a substitute for levothyroxine , which is involved in metabolism, growth and differentiation of cells;
• Thyrotome is a drug based on liothyronine and levothyroxine , which increases the metabolic rate, restores the functioning of the kidneys and liver;
• Triiodothyronine is a combined agent with liothyronine , which accelerates carbohydrate, fat and protein metabolism.

Do not exceed the dosage prescribed by your doctor. This is fraught with hyperthyroidism and its consequences – tachycardia, dysmenorrhea, heart failure.

Spa treatment

For women with a removed thyroid gland, an annual vacation by the sea is recommended . Sea air, sunbathing and swimming have a beneficial effect on the body, stimulate the immune system. To avoid complications, you need: 

• refuse to relax on the beach at midday;
• swim for 15-20 minutes a day with breaks;
• avoid overheating and hypothermia.

During the rehabilitation period, it is undesirable to visit the bathhouse or douche with cold water.

Pregnancy planning

A normal level of thyroid hormones is a prerequisite for the correct functioning of the organs of the reproductive system. They affect all types of metabolism, menstrual cycle, ovulation. In women, in the first few months of gestation, the level of thyroid hormones increases by an average of 40%. This is due to the active formation of the fetal endocrine system.

After removal of the thyroid lobes, pregnancy is not contraindicated. But conception is recommended only after the restoration of hormonal balance against the background of replacement therapy. Without proper treatment, uncompensated hypothyroidism occurs. It negatively affects the condition of women and provokes complications:

• spontaneous abortion;
• detachment of the placenta;
• intrauterine fetal death;
• congenital cretinism; 
• postpartum bleeding, etc.

Planning a pregnancy should be reported to an endocrinologist 3-4 months before conception.

Women wishing to have a baby should take into account several important points:

• Correction of hormone replacement therapy. During gestation, the need for levothyroxine increases. Therefore, after conception, the endocrinologist must increase the dosage of hormonal drugs.
• Change of diet. In the first trimester of gestation, the diet is the same as that prescribed immediately after surgery. Starting from the 4th month of pregnancy, you need to strictly control the daily calorie intake , which should be in the range of 2100-2200 kcal. Women should give preference to polyunsaturated fats and complex carbohydrates. Soy and refined foods are completely excluded from the diet.

Every month, pregnant women should be examined by an endocrinologist. Your doctor will increase or decrease the dose of hormone replacement therapy as needed. Compliance with HRT allows you to achieve medically compensated hypothyroidism. It practically does not affect the quality of life of patients and does not provoke endocrine diseases in children born after thyroidectomy .