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Roeylene Joyce G. Rubian Prof.

Oliver Marquez
BSN 3-B OR Rotation - Reporting

THYROIDECTOMY

Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at
the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to
how quickly you burn calories.

Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and
overactive thyroid (hyperthyroidism).

The surgical procedure of thyroidectomy involves a partial or a complete removal of the thyroid (a gland, which is
located in front of the lower neck, just above the trachea). The gland is formed by two cone-like lobes or wings (lobus
dexter (right lobe) and lobus sinister (left lobe), and attached by a middle part (isthmus).

Why it's done?


A thyroidectomy may be recommended for conditions such as:

Thyroid cancer. Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing
most, if not all, of your thyroid will likely be a treatment option.
Noncancerous enlargement of the thyroid (goiter). Removing all or part of your thyroid gland is an option if
you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if
the goiter is causing hyperthyroidism.
Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in which your thyroid gland produces
too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don't want radioactive
iodine therapy, thyroidectomy may be an option.

The two types of thyroidectomy include:


Total thyroidectomy: The gland is removed completely. Usually done in the case of malignancy. Thyroid replacement
therapy is necessary for life.
Subtotal thyroidectomy: Up to five-sixths of the gland is removed when antithyroid drugs do not correct
hyperthyroidism or RAI therapy is contraindicated.

Risk
Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy carries a risk of complications.
Potential complications include:
Bleeding
Infection
Airway obstruction caused by bleeding
Permanent hoarse or weak voice due to nerve damage
Damage to the four small glands located behind your thyroid (parathyroid glands), which can lead to
hypoparathyroidism, resulting in abnormally low calcium levels and an increased amount of phosphorus in your blood

Indications for Thyroidectomy:


A large goiter that is unlikely to react anti-thyroid drugs, may require surgery of the thyroid gland, to avoid pressure
on the trachea and esophagus, which then can cause difficulty breathing and swallowing, respectively.
Side effects of drug therapy or adherence to taking medication Persistent poor or non-response to radioactive iodine
therapy, up to repeated episodes of hyperthyroidism require excision of the thyroid gland.
Thyroidectomy used to negate the need for radioactive iodine therapy, especially in children.
In pregnant women, when drug therapy fails to control hyperthyroidism, thyroid operation organized
Violence and tumors of the thyroid gland require surgical excision.
It is also advisable in the case of clinical manifestations such as the rapid growth of the thyroid gland, severe pain,
and cervical lymphadenopathy, or when there have been prior to irradiation of the neck. A fine needle aspiration
cytology (FNAC) need to preformed to confirm the diagnosis and determine the type of operation.
Functionally or anatomically benign goiter, causing much anxiety among patients and is preferred to cut surgery for
cosmetic reasons.

How you prepare


Food and medications
If you have hyperthyroidism, your doctor may prescribe medication such as an iodine and potassium solution to
regulate your thyroid function and decrease the risk of bleeding.
You may need to avoid eating and drinking for a certain period of time before surgery, as well, to avoid anesthesia
complications. Your doctor will provide specific instructions.

Other precautions
Before your scheduled surgery, ask a friend or loved one to help you home after the procedure. Be sure to leave jewelry
and valuables at home.

What you can expect?


Before the procedure
Surgeons typically perform thyroidectomy during general anesthesia, so you won't be conscious during the procedure.
The anesthesiologist or anesthetist gives you an anesthetic medication as a gas to breathe through a mask or injects
a liquid medication into a vein. A breathing tube will then be placed in your trachea to assist breathing throughout the
procedure.

The surgical team places several monitors on your body to help make sure that your heart rate, blood pressure and
blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on your arm
and heart-monitor leads attached to your chest.

During the procedure


Once you're unconscious, the surgeon makes a small incision in the center of your neck or a series of incisions some
distance from the thyroid, depending on the surgical technique he or she uses. All or part of the thyroid gland is then
removed, depending on the reason for the surgery.
If you're having thyroidectomy as a result of thyroid cancer, the surgeon may also examine and remove lymph nodes
around your thyroid. Thyroidectomy usually takes a few hours.

There are three main approaches to thyroidectomy:


Conventional thyroidectomy involves making an incision in the center of your neck to directly access your thyroid
gland.
Endoscopic thyroidectomy uses smaller incisions in the neck. Surgical instruments and a small video camera are
inserted through the incisions. The camera guides your surgeon through the procedure.
Robotic thyroidectomy is performed either through incisions in the chest and armpit or via an incision high in the
neck. The robotic approach allows a thyroidectomy to be performed while avoiding an incision in the center of your
neck.

After the procedure


After surgery, you're moved to a recovery room where the health care team monitors your recovery from the surgery
and anesthesia. Once you're fully conscious, you'll be moved to a hospital room.
You may have a drain under the incision in your neck. This drain is usually removed the morning after surgery.

After a thyroidectomy, you may experience neck pain and a hoarse or weak voice. This doesn't necessarily mean there's
permanent damage to the nerve that controls your vocal cords. These symptoms are often temporary and may be due
to irritation from the breathing tube (endotracheal tube) that's inserted into your windpipe (trachea) during surgery, or
as a result of nerve irritation caused by the surgery.

You'll be able to eat and drink as usual after surgery. Depending on the type of surgery you had, you may be able to go
home the day of your procedure or your doctor may recommend you stay overnight in the hospital.
When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing
anything vigorous, such as heavy lifting or strenuous sports.

Action to reduce the Acute Pain related to postoperative thyroidectomy


1. Study the presence of pain symptoms, both verbal or nonverbal, note the location, intensity (scale of 0-10), and
duration.
Rationale: useful in evaluating pain, determine the choice of interventions to determine effectiveness of therapy.
2. Give patients in semi-fowlers position and support the head / neck with a small pillow.
Rationale: prevent hyper-extension neck and protect the integrity of the suture line.
3. Suggest patients use relaxation techniques, such as imagination, soft music, progressive relaxation.
Rationale: help to refocus attention and help patients to cope with pain / discomfort more effectively.
4. Give & evaluation prescribed analgesic effectiveness.
Rationale: Analgesics should be at great pains to block pain.

The long-term effects of thyroidectomy depend on how much of the thyroid is removed.

Partial thyroidectomy
If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid
gland, and you might not need thyroid hormone therapy.

Complete thyroidectomy
If your entire thyroid is removed, your body can't make thyroid hormone and without replacement you'll develop signs
and symptoms of underactive thyroid (hypothyroidism). As a result, you'll need to take a pill every day that contains
the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, Unithroid).
This hormone replacement is identical to the hormone normally made by your thyroid gland and performs all of the
same functions. Your doctor will determine the amount of thyroid hormone replacement you need based on blood tests.

Common occurrence after Thyroidectomy


There will be episodes of pain, swelling, and bruising around the wound area.
Voice may be hoarse. But, this is usually temporary and tone of voice to get back to normal after a few days.
During the first few days, eating and drinking can be associated with some discomfort and pain.
You will feel a bit sluggish and tired after the surgery.
Area can be washed after 7 to 10 days.
Light jobs can be done after a period of 2 weeks.

Nursing Care Plans

Thyroidectomy requires meticulous postoperative nursing care to prevent complications.


Here are five (5) thyroidectomy nursing care plans:
Acute Pain
Risk for Impaired Airway Clearance
Impaired Verbal Communication
Risk for Injury
Deficient Knowledge

Nursing Priorities
Reverse/manage hyperthyroid state preoperatively.
Prevent complications.
Relieve pain.
Provide information about surgical procedure, prognosis, and treatment needs.

Discharge Goals
Complications prevented/minimized.
Pain alleviated.
Surgical procedure/prognosis and therapeutic regimen understood.
Plan in place to meet needs after discharge.Nursing Interventions for Postoperative Thyroidectomy

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