Ppt 18 Thyroid Cancer

Cancer of the thyroid

◦ Cancer of the thyroid is less prevalent than other forms of cancer.
◦ The most common type, papillary adenocarcinoma, accounts for more than half of thyroid malignancies; it
starts in childhood or early adult life, remains localized, and eventually metastasizes.
◦ When papillary adenocarcinoma occurs in an elderly patient, it is more aggressive.
◦ Risk factors include female gender and external irradiation of the head, neck, or chest in infancy and
childhood.
◦ Other types of thyroid cancer include follicular adenocarcinoma, medullary, anaplastic, and thyroid
lymphoma.
Clinical Manifestations
◦ Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy suggest
malignancy.
Assessment and Diagnostic Methods
◦ Needle biopsy or aspiration biopsy of thyroid gland
◦ Thyroid function tests
◦ Ultrasound, MRI, CT scan, thyroid scans, radioactive iodine uptake studies, and thyroid suppression tests
Medical Management
◦ Treatment of choice is surgical removal (total or near-total thyroidectomy).
◦ Modified or extensive radical neck dissection is done if lymph nodes are involved.
◦ Radioactive iodine is used to eradicate residual thyroid tissue.
◦ Thyroid hormone is administered in suppressive doses after surgery to lower the levels of thyroid-
stimulating hormone (TSH) to a euthyroid state.
◦ Lifelong thyroxine is required if remaining thyroid tissue is inadequate to produce sufficient hormone.
◦ Radiation therapy is administered by several routes.
◦ Chemotherapy is used only occasionally.
Nursing Management
◦ See “Nursing Management” under “Cancer” for additional information.
◦ Inform the patient about the purpose of any preoperative tests and explain what preoperative
preparations to expect; teaching includes demonstrating to the patient how to support the neck with the
hands after surgery to prevent stress on the incision.
◦ Provide postoperative care (e.g., assess and reinforce surgical dressings, observe for bleeding, monitor
pulse and blood pressure for signs of internal bleeding, assess respiratory status, assess intensity of pain
and administer analgesics as prescribed).
◦ Monitor and observe for potential complications such as hemorrhage, hematoma formation, edema of
the glottis, and injury to the recurrent laryngeal nerve.
◦ Teach patient and family about signs and symptoms of possible complications and those that should be
reported; suggest strategies for managing postoperative pain at home and for increasing humidification.
◦ Explains to the patient and family the need for rest, relaxation, and nutrition; patient can resume former
activities and responsibilities once recovered from surgery.
◦ Refer for home care, if indicated.
Quality and Safety Nursing Alert
Following thyroid surgery, the patient should be monitored closely for
 signs of tetany,
 including hyperirritability of the nerves,
 with spasms of the hands and feet and muscle twitching.
 Laryngospasm, although rare, may occur and obstruct the airway.