Foundation University

COLLEGE OF NURSING
Dumaguete City

WARD CLASS
Thyroidectomy

Submitted to:
Mr. Kenneth Corales, LPT, RN

Submitted by:
CABALLO, Cloie Alexi K.
DAUG, Jenessel Ann P.
Purpose: The purpose of this study is to provide students with comprehensive knowledge on Thyroidectomy. By the end of the discussion, participants will
be able to define the said disease, its overview, clinical manifestations, assessment and diagnostic findings and medical and surgical management.
Goal: The goal of this study is to equip nursing students with the necessary knowledge on Thyroidectomy along with its overview, clinical manifestations,
assessment and diagnostic findings and medical and surgical management.

METHOD TIME METHOD OF

OBJECTIVES CONTENT OUTLINE OF ALLOTTED RESOURCES EVALUATION
INSTRUC
TION

1. Give an I. Overview and Clinical Lecture and 20 minutes Professional, C. C. M. Question and Answer
overview on Manifestations on Thyroidectomy presentation (n.d.). Thyroidectomy.
Thyroidectomy and Thyroid Cancer Cleveland Clinic. 1. What is
and Thyroid https://my.clevelandclinic Thyroidectomy?
Cancer. Thyroidectomy - surgical removal of What is Thyroid
.org/health/treatments/70
all or part of the thyroid gland Cancer?
16-thyroidectomy
2. Understand the Thyroid cancer - develops in your Lecture and 20 minutes 2. What are the
clinical thyroid, a small, butterfly-shaped presentation Professional, C. C. M. clinical
manifestations gland at the base of your neck. This (n.d.-a). Thyroid cancer. manifestations
of Thyroid gland produces hormones that regulate Cleveland Clinic. of Thyroid
Cancer. your metabolism (how your body uses https://my.clevelandclinic Cancer?
energy). Thyroid hormones also help .org/health/diseases/1221
control your body temperature, blood 0-thyroid-cancer 3. What are the
3. Discuss the pressure and heart rate. Thyroid Lecture and 20 minutes medical and
medical and cancer, a type of endocrine cancer, is presentation Thyroid cancer - surgical
surgical generally highly treatable, with an management of
Symptoms and causes -
management of excellent cure rate. Thyroid Cancer?
Mayo Clinic. (2023, April
Thyroid Cancer.
Thyroidectomy is the main surgical
26). Mayo Clinic. 4. What is the
treatment for thyroid cancer and is a https://www.mayoclinic.o appropriate
4. Discuss the treatment option for certain thyroid Lecture and 20 minutes rg/diseases-conditions/thy nursing
appropriate conditions, including: presentation roid-cancer/symptoms-ca management for
nursing uses/syc-20354161#:~:tex Thyroidectomy?
management for Thyroid nodules: A thyroid nodule is t=Typically%2C%20thyr
Thyroidectomy. a growth (lump) of thyroid cells in
oid%20cancer%20doesn't
your thyroid gland. Thyroid nodules
,in%20their%20neck%20
5. Ask the are usually benign (noncancerous), but Lecture and 20 minutes
participants they can be malignant (cancerous). presentation
or%20throat.
questions to Sometimes, thyroid nodules can
gauge their produce excess thyroid hormone,
understanding of which causes certain symptoms.
the disease.
Goiter: Goiter is an enlarged thyroid
gland with or without thyroid nodules.
If it grows large enough, it can put
pressure on your trachea or food pipe
(esophagus) and make it more difficult
to breathe and swallow.

Hyperthyroidism: Hyperthyroidism
(overactive thyroid) is a condition in
which your thyroid creates and
releases more hormones than you
need. It has several causes, and
surgery is one of the treatment options
for the condition.

Two main categories of

thyroidectomies: Total and partial.
Types of partial thyroidectomies,
which involve removal of part of your
thyroid include:

Hemi-thyroidectomy or thyroid
lobectomy: The surgeon removes one
lobe (one half) of your thyroid.

Isthmusectomy: The surgeon removes

the thyroid tissue between the two
lobes (thyroid isthmus). Surgeons
perform this surgery specifically for
small tumors that are located in the
isthmus.

Open thyroid biopsy: In this operation,

the surgeon removes a thyroid nodule
directly. Surgeons rarely perform this
surgery.

Clinical manifestations of Thyroid

Cancer:

- A lump (nodule) that can be felt

through the skin on your neck
-A feeling that close-fitting shirt
collars are becoming too tight
-Changes to your voice, including
increasing hoarseness
-Difficulty swallowing
-Swollen lymph nodes in your neck
-Pain in your neck and throat

II. Assessment and Diagnostic

Findings

Lesions that are single, hard, and fixed

on palpation or associated with
cervical lymphadenopathy suggest
malignancy.

Thyroid function tests may be helpful

in evaluating thyroid nodules and
masses; however, results are rarely
conclusive.

An ultrasound-guided fine needle

biopsy of the thyroid gland is the
standard diagnostic procedure for
evaluating thyroid nodules. It is
performed as an outpatient procedure
to make a diagnosis of thyroid cancer,
to differentiate cancerous thyroid
nodules from noncancerous nodules,
and to stage the cancer if detected
(Amdur & Dagan, 2019). The
procedure is safe and usually requires
only a local anesthetic agent.

Additional diagnostic studies include

ultrasound, MRI, CT, thyroid scans,
radioactive iodine uptake studies, and
thyroid suppression tests.

III. Medical and Surgical

Management

The medical management depends on

the classification of cell type found on
biopsy.

Three common groups:

- well-differentiated thyroid cancer
(DTC)
- papillary thyroid carcinoma (PTC)
- follicular thyroid carcinoma (FTC)
(Amdur & Dagan, 2019)

Total or near-total thyroidectomy -

treatment of choice for localized
thyroid carcinoma

Modified neck dissection or more

extensive radical neck dissection is
performed if there is lymph node
involvement.

Thyroid hormone - given after

surgery to lower the levels of TSH to a
euthyroid state (Bauerle & Riek,
2019). If the remaining thyroid tissue
is inadequate to produce sufficient
thyroid hormone, thyroxine is required
permanently.

IV. Nursing Management

Important preoperative goals are to

prepare the patient for surgery and
reduce anxiety. Often, the patient’s
home life has become tense because of
their restlessness, irritability, and
nervousness secondary to
hyperthyroidism. Efforts are necessary
to protect the patient from tension and
stress to avoid precipitating thyroid
storm. Suggestions are made to limit
stressful situations. Quiet and relaxing
activities are encouraged.

Providing Preoperative Care

The nurse educates the patient about

the importance of eating a diet high in
carbohydrates and proteins. A high
daily caloric intake is necessary
because of the increased metabolic
activity and rapid depletion of
glycogen reserves. Supplementary
vitamins, particularly thiamine and
ascorbic acid, may be prescribed. The
patient is reminded to avoid tea,
coffee, cola, and other stimulants.
The nurse also informs the patient
about the purpose of preoperative
tests, if they are to be performed, and
explains what preoperative
preparations to expect. This
information should help to reduce the
patient’s anxiety about the surgery. In
addition, special efforts are made to
ensure a good night’s rest before
surgery.
Preoperative education includes
demonstrating to the patient how to
support the neck with the hands after
surgery to prevent stress on the
incision. This involves raising the
elbows and placing the hands behind
the neck to provide support and reduce
strain and tension on the neck muscles
and the surgical incision.

Providing Postoperative Care

In the postoperative period, the

priorities are to observe for any
difficulty in breathing due to edema of
the glottis, hematoma formation, or
injury to the recurrent laryngeal nerve
which requires the insertion of an
airway, and to monitor the pulse and
blood pressure for any indication of
internal bleeding. The nurse must be
alert for complaints of a sensation of
pressure or fullness at the incision site
which may indicate subcutaneous
hemorrhage and hematoma formation
and should be reported. In addition,
the nurse periodically assesses the
surgical dressings and reinforces as
necessary. When the patient is in a
recumbent position, the nurse
observes the sides and the back of the
neck as well as the anterior dressing
for bleeding. A tracheostomy set is
kept at the bedside at all times, and the
surgeon is summoned at the first
indication of respiratory distress. If the
respiratory distress is caused by
hematoma, surgical evacuation is
required.
The intensity of pain is assessed, and
analgesic agents are given as
prescribed for pain. The nurse should
anticipate apprehension in the patient
and should inform the patient that
oxygen will assist breathing. When
moving and turning the patient, the
nurse carefully supports the patient’s
head and avoids tension on the
sutures. The most comfortable
position is the semi- Fowler position,
with the head elevated and supported
by pillows.
IV fluids are given during the
immediate postoperative period. Water
may be given by mouth as soon as
nausea subsides and bowel sounds are
present. Usually, there is a little
difficulty in swallowing; initially, cold
fluids and ice may be taken better than
other fluids. Often, patients prefer a
soft diet to a liquid diet in the
immediate postoperative period.

The patient is advised to talk as little

as possible to reduce edema to the
vocal cords; however, when the
patient does speak, any voice changes
are noted, indicating possible injury to
the recurrent laryngeal nerve, which
lies just behind the thyroid next to the
trachea. An overbed table is provided
for access to frequently used items so
that the patient avoids turning their
head. The table can also be used to
support a humidifier when vapor-mist
inhalations are prescribed for the relief
of excessive mucous accumulation.