Will I Need Thyroid Tablets for Life After Thyroidectomy?

After a total thyroidectomy, replacement tablets are needed permanently because nothing is left to make thyroid hormones. However, when only one lobe is removed, the remaining lobe often works well enough, and many patients never need tablets. The need for medication depends on the extent of surgery and the function of the remaining thyroid.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in Bengaluru at MACS Clinic, patients tend to dread the word “lifelong” and imagine a heavy burden. In practice it usually means one small tablet each morning and a blood test now and then. It helps to ask this before the operation, when the extent of surgery is still being decided, so nothing comes as a surprise afterwards.

• Total thyroidectomy. With the whole gland gone, levothyroxine is always needed, and it continues for life. If the operation is for cancer, the thyroid cancer treatment page shows how the extent of surgery is chosen.
• Hemithyroidectomy (lobectomy). One lobe stays behind. Reported figures differ between studies, from about 15 to 50 percent, with around one in three on tablets a few years later. The rest keep normal thyroid function.
• Who is more likely to need them. A high TSH before surgery, Hashimoto’s thyroiditis (autoimmune thyroid inflammation), a cancer diagnosis on the pathology report and a small remaining lobe all raise the chance.
• Completion thyroidectomy. Sometimes cancer is found only after a lobectomy, and the other lobe has to be taken out too. That patient then falls into the total thyroidectomy group and needs tablets permanently.
• Starting early isn’t always forever. A few patients are put on tablets soon after a lobectomy and are later able to stop, once blood tests show the remaining lobe is coping.
• Tablets are not a failure. They just stand in for the hormone the gland would have made.

• The daily routine. A single levothyroxine tablet, taken with water on an empty stomach, around half an hour to an hour before breakfast. Leave a gap of some hours from calcium and iron supplements.
• The dose. It starts from body weight and is then fine-tuned by TSH blood tests, which are repeated about 6 to 8 weeks after any change. Once things settle, a yearly or twice-yearly check is usual. Please don’t alter the dose on your own.
• Energy and weight. When the dose is right, most people return to their usual routine. Tiredness, weight gain or feeling cold early on often mean the dose needs adjusting.
• Calcium. A total thyroidectomy can bruise the tiny parathyroid glands beside the thyroid, which brings calcium down for a while. Tingling around the lips or in the fingertips is the usual clue, so mention it, as it normally settles.
• Scarless surgery. Robotic or scarless operations move the incision away from the neck but don’t change how much thyroid comes out, so the answer on tablets stays the same. The robotic cancer surgery page describes the approaches.
• Pregnancy. Many women need a higher dose during pregnancy, so tell the doctor as soon as you know.