THYROIDECTOMY

Definition of thyroidectomy

It is the surgical removal of the thyroid gland partially or totally for benign or malignant tumor,
hyperthyroidism, thyrotoxicosis, or thyroiditis

Indications

 Pressure symptoms – dysnoea, dysphagia, hoarseness of voice, fast enlargement of goitre

 Pressure on the trachea cosmetic purposes
 Malignancy or suspected malignancy
 Haemorrhage in the gland
 Recurrent thyrotoxicosis following drug treatment
 Patient is unsuitable for radioactive therapy

PRE AND POST-OPERATIVE CARE

1.Pre op care
Pre-operative care

 Admit the patient one or two weeks before surgery to control hyperthyroidism and to
familiarize patient with staff and ward environment
 The client is usually given antithyroid agents 1- 2 weeks before surgery to achieve a euthyroid
state and minimize the risk of thyroid crisis
 Explain about the investigations to be done in time before the surgery

Psychological care

Explain about the incision and healing process in general to allay anxiety

Explain that the incision might be barely noticeable and the scar will fade and eventually will look like a
normal neck wrinkle

Reassure the patient that a scarf, jewelry, high color or other covering can effectively camouflage a fresh
scar

Tell the patient about the anticipated iv fluids, drains, clips and sutures or pressure bandages

Make the client to familiarizes with the hospital staff to reduce anxiety

Tell patient that talking is likely to be difficult for sometime after surgery

rest
  ensure complete mental and physical rest
 promote quietness and freedom from stress
 allow few visitors and friends to promote rest
 establish a good nurse patient relationship to gain the patient cooperation
 the nurse should ensure that ward activities are grouped to allow for rest periods
 minimize noise in the room to promote sleep
 night sedatives like diazepam are given to ensure a good night sleep

Diet

 high carbohydrate diet to meet high metabolic rate.

 Patient should be given proteins in a balance diet to maintain the nitrogen balance
 Weight patient daily to assess weight gain or loss
 Give plenty of oral flied to reduce toxicity avoid stimulant like coffee to decrease nervous
stimulation
 Give multivitamins to boost appetite

Drugs

 Lugos iodine solution 15-30 drops for 10 -14 day before surgery to help reduce vascularity and
make the gland firm and makes it easy to operate
 Potassium chloride for proper functioning of the myocardium

Management

Medical management

 Anti- thyroid agents eg Carbimazole 10-20 mg 8 hourly to reduce the activity of the thyroid
gland. Maintenance dose is 15 mg daily
 Propyl-Thyracil 100 – 400 mg daily to block synthesis of thyroid hormones
 Propranolol 40mg 8hrly to control cardiac symptoms
 Diazepam 5-10 mg nocte for sedation
 Digoxin for arterial fibrillation

Observation

 Observe the patient reaction to visitors monitor for sighs of anxiety e.g. restlessness
 Monitor weight gain
 Check sleeping pulse to assess degree of anxiety
 Inspect vocal cords and check for mobility
 Observe vital signs BP, temperature, pulse respirations

Exercises

 Pre operatively, teach the patient comfort and safety measures I which he or she can
parti9cipate
 Coughing, deep breathing and turning exercises and should be practiced and explain their
importance
  taught to support the head manually while turning I bed because this maneuver minimizes
stress on the suture line post-surgery
 range of motion exercises of the neck should be practiced on the day before operation

day before

 shave the area of operation from the neck, upper half of the chest, axilla and upper arms
 reinforce full expplation of the procedure to the patint to reduce anxirty
 obatain a si9gned consent form
 book paietnt in thater
 ensure premediacation is ordered
 clean patient well with soap and water
 check if all investigation that were ordered and report abnormalitys
 collect an dassemple all paietnt notes
 keep in place:
 oxygen tank with working gauge
 working suction machine
 drip stand and iv fluids
 ensure clean bed linen
 Cross match and retain blood
 anesthetist to assess patient and check premedication
 give light diet

night before

 give a light diet for super

 keep nil per oral after wards
 keep patient’s belongings in a safe
 give sedative to ensure a good sleep

Morning of operation

 reassure patient
 give a bath
 catheterize patient to empty bladder
 thorough cleaning of op site with soap and water
 clean with antiseptic solution and cover with a clean towel
 dress patient in theatre attire
 check baseline vital observations for BP, temperature, pulse and respirations
 give medication as ordered
 put patient on stretcher, wheel to theatre and handover patient to theater staff

Nursing diagnoses

 anxiety related to unknown outcome of the procedure

  knowledge deficit regarding treatment modalities and expectations of the impending procedure
 risk for injury related to inadequate preoperative preparation (euthyroid state not achieved)
 risk of fluid volume deficit related to operation of a highly vascular organ

2.Post op care
Nursing problems
Pain
Hemorrhage
Altered body image
Risk for infection
Difficulty in swallowing
Altered speech pattern
Ineffective breathing
Altered nutrition
Activity intolerance
Self-care deficit within 24 -72 hours

Nursing diagnoses

Risk for hypocalcemia related to removal or damage of parathyroid gland of damage to blood vessels
supplying parathyroid glands

 monitor serum calcium levels

 advice patient to report promptly of peripheral paranesthesia because this is an early indicator
of hypocalcemia
 rule out hyperkalemia and hypomagnesemia as these potentiate cardiac and neuromuscular
irritability
 administer calcium gluconate iv as prescribed, oral calcium, and Vitamin D
 Safety measures e.g. padded bed side rails to prevent injury during seizures

risk for ineffective breathing pattern related to haematoma, laryngeal oedema, vocal paralysis,
diminished ability to clear secretions

 keep the head of the bed elevated 45 degrees to limit formation of oedema at the surgical site
 use an ice collar as appropriate to decrease oedema formation
 encourage deep breathing and use of an incentive spirometer every hour to keep alveoli open
and promote effective breathing
 instruct the patient to cough as needed to clear secretions. (excessive forceful coughing can
irritate the incisional area)
  suction as needed to clear secretions hen the patient is unable to do so
 administer humidified oxygen as needed to promote easier breathing and thinner secretions

Complications

Tachycardia
Hemorrhage
Respiratory Distress
Oedema
Infection
Dysphagia Dyspnea
Injury Of Laryngeal Nerve
Storm Crisis
Myxedema