Trajada, Domingo, Jr., M.

Thyroidectomy

Definition

 Removal of all or a portion of the thyroid

gland.

Discussion

 Types

1. Hemithyroidectomy - entire isthmus is removed along with 1 lobe. Done in

benign diseases of only 1 lobe.
2. Subtotal thyroidectomy - done in toxic thyroid. primary or secondary and also for
toxic MNG
3. Partial thyroidectomy - removal of gland in front of trachea after mobilization. It
is done in nontoxic MNG. role is controversial.
4. Near total thyroidectomy - Both lobes are removed except for a small amount of
thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal
nerve entry point and the superior parathyroid gland.
5. Total thyroidectomy- Entire gland is removed. Done in case of follicular
carcinoma of thyroid, medullary ca of thyroid.
6. Hartley Dunhill operation- removal of 1 entire lateral lobe with isthmus and
partial/subtotal removal of opposite lateral lobe. It is done in non toxic MNG.

 Indication

A thyroidectomy may be recommended for conditions such as:

 Malignancy (see Thyroid neoplasm)

 Cosmetic reasons
 Goiter which is untreatable by medical methods
 Severe hyperthyroidism refractory to conservative treatment
 Orbitopathy in Graves' disease
 Removal and evaluation of a thyroid nodule whose FNAC results are unclear
  Risk

Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy

carries a risk of complications.

1. Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years

2. Laryngeal nerve injury in about 1% of patients, in particular the recurrent
laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage
presents as laryngeal obstruction after surgery and can be a surgical emergency:
an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury
may occur during the ligature of the inferior thyroid artery.
3. Hypoparathyroidism temporary (transient) in many patients, but permanent in
about 1-4% of patients
4. Anesthetic complications
5. Infection
6. Stitch granuloma
7. Chyle leak
8. Haemorrhage/Hematoma
o This may compress the airway, becoming life-threatening.
9. Surgical scar/keloid
10. Removal or devascularization of the parathyroids.
11. Thyroid storm in operations performed for hyperthyroidism

Position

 Supine with rolled towel or sandbag between the scapulae, hyperextending the
neck. If table is placed in reverse Trendelenberg position, a padded foot board
should be used to prevent the patient from slipping down toward the end of the
table.

Pack/ Drapes

 Laparotomy pack with small fenestrated sheet

 Rolled sheet/ towels

Instrumentation

 Major Lap tray

 Thyroid tray
 Lahey clamps
 Spring retractor

Supplies/ Equipment

 Basin set
 Suction
  Blades
 Needle counter
 Dissector sponge
 Small drain
 Solutions
 Sutures

Procedure Overview

1. The incision is made above the sternal notch.

2. The platysma muscle is incised and retracted.
3. The strap muscles are separated or divided, and blunt and sharp dissections are
employed until the thyroid is exposed.
4. The gland is then mobilized, and all or part is removed depending on the involved
pathology.
5. Hemostasis is obtained, and the wound is irrigated with warm saline.
6. A drain may be inserted, and the incision is closed in layers by an interrupted
method.

Perioperative Nursing Consideration

1. The surgeon may request a fine silk suture to use to mark the incision line.
2. The dressing is usually secured by a thyroid collar using a towel folded in thirds
lengthwise. The towel is placed around the neck and crisscrossed in front, then
fastened with tape.
3. The scrub person should maintain the sterility of the back table/ Mayo until the
patient is extubated and breathing is stabilized.
4. An emergency tracheostomy tray will accompany the patient to the postanesthesia
care unit and later to the patient’s room until breathing is unlabored and the
chance of airway obstruction secondary to edema has passed.