Thyroidectomy

  1. General information
    1. Partial or total removal of the thyroid gland
    2. Indications
      1. Subtotal thyroidectomy: hyperthyroidism
      2. Total thyroidectomy: thyroid cancer
  2. Nursing interventions: preoperative
    1. Ensure that the client is adequately prepared for surgery.
      1. Cardiac status is stable.
      2. Weight and nutritional status are normal.
    2. Administer antithyroid drugs as ordered to suppress the production and secretion of thyroid hormone and to prevent thyroid storm.
    3. Administer iodine preparations (Lugol's or potassium iodide solution) to reduce the size and vascularity of the gland and prevent hemorrhage.
  3. Nursing interventions: postoperative
    1. Monitor vital signs and I&O.
    2. Check dressings for signs of hemorrhage; check for wetness behind neck.
    3. Place client in semi-Fowler's position and support head with pillows.
    4. Observe for respiratory distress secondary to hemorrhage, edema of the glottis, laryngeal nerve damage, or tetany; keep tracheostomy set, oxygen, and suction nearby.
    5. Assess for signs of tetany due to hypocalcemia secondary to accidental removal of parathyroid glands; keep calcium gluconate available (see Hypoparathyroidism, below).
    6. Encourage the client to rest voice.
      1. Some hoarseness is common.
      2. Check every 30-60 minutes for extreme hoarseness or any accompanying respiratory distress.
    7. Observe for thyroid storm due to release of excessive amounts of thyroid hormone during surgery.
    8. Administer IV fluids as ordered until the client is tolerating fluids by mouth.
    9. Administer analgesics as ordered for incisional pain.
    10. Relieve discomfort from sore throat.
      1. Cool mist humidifier to thin secretions.
      2. Administer analgesic throat lozenges before meals and prn as ordered.
      3. Encourage fluids.
    11. Encourage coughing and deep breathing every hour.
    12. Assist the client with ambulation: instruct the client to place hands behind neck to decrease stress on suture line if added support necessary.
    13. Provide client teaching and discharge planning concerning
      1. Signs and symptoms of hypo/hyperthyroidism
      2. Self-administration of thyroid hormones if total thyroidectomy performed
      3. Application of lubricant to the incision once sutures are removed
      4. Performance of ROM neck exercises 3-4 times a day
      5. Importance of regular follow-up care

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