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Thyroidectomy
Description
- The surgical removal of part or all the thyroid
gland. It allows treatment of hyperthyroidism,
respiratory obstruction from goiter, and thyroid
cancer.
Types:
1. Thyroid Lobectomy- removal of only
about a quarter of the gland
2. Subtotal Thyroidectomy- removal of
half of the thyroid; is used to correct
hyperthyroidism when drug therapy fails
or radiation therapy is contraindicated. It
also effectively treats diffuse goiter.
After surgery, the remaining thyroid
tissue usually supplies enough thyroid
hormone for normal function.
3. Total Thyroidectomy- may be
performed for certain types of thyroid
cancer, such as papillary, follicular,
medullary or anaplastic neoplasms.
After this surgery, the patient requires
lifelong thyroid hormone replacement
therapy.
Affected organ
• The thyroid gland is found in the neck,
inferior to the thyroid cartilage (also
known as the 'Adam's Apple') and at
approximately the same level as the
cricoid cartilage.
• The thyroid gland is situated in the neck
in relation to 2nd, 3rd and 4th tracheal
rings. The right and left lobes are joined
by an isthmus.
• The thyroid controls how quickly the
body uses energy, makes proteins, and
controls how sensitive the body should
be to other hormones.
• The thyroid gland participates in these
processes by producing thyroid
hormones, principally triiodothyronine
(T3) and thyroxine (T4). These
hormones regulate the rate of
metabolism and affect the growth and
rate of function of many other systems
in the body.
• T3 and T4 are synthesized utilizing both
iodine as well as tyrosine. The thyroid
gland also produces a hormone called
'calcitonin', which plays a role in
calcium homeostasis.
• The thyroid gland is controlled by the
hypothalamus and pituitary
(specifically, the anterior pituitary).
• The most common problems of the
thyroid gland consist of an over-active
thyroid gland, referred to
'hyperthyroidism', and an under-active
thyroid gland, referred to
'hypothyroidism'.
Anesthesia Used
• Thyroid surgery is more commonly
performed with general anesthesia.
• Some surgeons are now using local
anesthesia, plus a sedative, however, to
perform thyroid surgery.
• The benefits of local anesthesia are that
it is associated with a shorter hospital
stay, shorter actual surgery time, and
less vomiting and nausea after surgery.
You will, however, be awake during the
surgery, and able to interact with your
surgeon.
Skin Preparation
The entire front of neck, from jaw line to nipples
is cleaned with Betadine.
Draping
-Sterile sheets are draped above, below and on
either sides of neck, keeping only neck portion
visible.
Operative technique
The patient is placed in a supine
position with the neck extended with cloth
roll or sand bag placed under the shoulders.
After the patient is anesthetized, the surgeon
determines the incision line by measuring
bilaterally from each clavicle. Then he makes a
3 to 5 inches curvilinear skin incision through
the skin, fascia, muscle and skin flaps from the
strap muscles. He separates these muscles
midline, revealing the thyroid’s isthmus and
clamps, divides and ligates the thyroid artery
as
as
and veins with 2-0 vicryl to help prevent
bleeding. Next he locates and visualizes the
laryngeal nerves and parathyroid glands and
then begins dissection and removal of thyroid
tissue, trying not to injure nearby structures.
Before the surgeon sutures the incision,
he may insert a Penrose drain or c closed wound
drainage device such as a Hemovac.
 A newer technique, known as 1 Metzenbaum scissors curve sharp points > Ask the patient to speak as soon as he awakens
endoscopic thyroid surgery, involves using a 1 Metzenbaum scissors curve from anesthesia- to check for laryngeal nerve
small magnifying camera inserted in the neck. 2 Lovelace forcep straight damage.
Carbon dioxide gas is pumped into the neck area 1 Lahey Retractor > Watch for respiratory distress, obstruction,
to help make it easier to see and work on the 1 Green Retractor stridor and restlessness. Keep a tracheotomy tray
gland. A second small incision is made, and a 1 Little Retractor at bedside for 24 hours.
thin tube with a scalpel-like edge is inserted 1 Cushing Vein Retractor > NPO for 24 hours, then starting with clear
through that incision. This tube is the surgical 6 Lahey Goiter Tenaculum Forceps liquids at 2nd day then to soft diet going to
tool that is used to remove the thyroid. normal diet.
Nursing Considerations > Assess for signs of hemorrhage- check
Complications dressing and palpate back of neck. Expect about
Before surgery
• Hemorrhage 50 ml of drainage in the first 24 hours. Expect
> Explain to the patient the procedure. (Presence only scanty amount after 24 hours. Drainage
• Laryngeal nerve damage
of incision in neck, dressing, a possible drain, usually removed after 48 hours.
• Vocal cord damage hoarseness of voice)
• Parathyroid damage > Assess for hypocalcemic tetany- sign of
> Notify the physician is the patient has failed to damaged parathyroid. Test for Chvostek’s and
• Thyroid storm follow preoperative drug regimen: Trousseau’s signs. Keep calcium gluconate
• Wound infection -Propylthiouracil or methimazole- to prevent available at bedside.
thyroid storm > Be alert for signs of thyroid storm, a rare but
OR Instruments -Iodine- to reduce gland’s vascularity and serious complication.
1 Iris scissors straight prevent bleeding > As ordered, administer a mild analgesic to
1 Iris scissors curve -Propanolol- to block adrenergic effects
1 Baby metzenbaum curve relieve sore throat.
>Check preoperative investigations (CBC, T3, > Rise of temperature after 3rd postoperative day
1 Plastic surgery scissors straight T4, TSH, Ultrasound of thyroid gland, radio-
1 Ragnell scissors indicates infection.
iodine scan of thyroid, x-ray of neck, fine-needle > Sutures are usually removed on the 5th
1 Adson Dressing Forcep aspiration biopsy).
1 Adson Tissue Forcep postoperative day.
T3- 60-181 ng/dl
1 Brown-Adson Tissue
T4- 4.5-12.5 mcg/dl Home care
2 Mosquito straight
TSH- 0.5-4.70 microIU/ml > If patient had total Thyroidectomy, explain
2 Mosquito curve
1 Kelly forcep curve PT- 2-20 y/o- 9-52 pg/ml; >20 y/o- 8-97pg/ml importance of regular thyroid hormone
1 Crile forcep curve > Maintain aspiration precautions. replacement. Teach him to recognize signs of
2 Gemini-mixture forcep curve > Ensure that the patient or legal representative hypo and hyperthyroidism.
8 Backhaus Towel Clamp has signed an informed consent. > If parathyroid damage occurred, explain that
1 Foerster sponge forcep he’ll need to take calcium supplements. Teach
1 Webster needle holder 5” During surgery him to recognize signs of hypocalcemia.
1 Crile-Wood Needle Holder 6” > Monitor the patient for signs of complications. > Tell him to keep incision site clean and dry.
1 Jansen retractor > Assist the surgeon during the surgery. Help him to cope with concerns about its
2 Senn retractors appearance.
1 Weitlaner Retractor blunt After surgery > Arrange follow-up appointments.
2 Allis Tissue Forceps > Keep the patient in high fowlers to promote
1 Frazier Ferguson Suction Tube 9 Fr. venous return from the head and neck and to Passed by: Jan Howell M. Yap BSN4R Grp 4A
2 Joseph Skin Hook, single decrease oozing into the incision. Passed to: Mr. Rodolfo Hernandez, Jr., RN
2 Joseph Skin Hook, double