Thyroidectomy, although rare, may be performed for patients with thyroid cancer, hyperthyroidism, and drug reactions to antithyroid agents; pregnant women who cannot be managed with drugs; patients who do not want radiation therapy; and patients with large goiters who do not respond to anti-thyroid drugs.
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.
Thyroidectomy requires meticulous postoperative nursing care to prevent complications. Nursing priorities will include managing hyperthyroid state preoperatively, relieving pain, providing information about the surgical procedure, prognosis, and treatment needs, and preventing complications.
- Acute Pain
- Risk for Impaired Airway Clearance
- Impaired Verbal Communication
- Risk for Injury
- Deficient Knowledge
Risk for Injury
Risk factors may include
- Chemical imbalance: excessive CNS stimulation
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- Client will demonstrate an absence of injury with complications minimized/controlled.
|Monitor vital signs noting elevated temperature, tachycardia, arrhythmias, respiratory distress, cyanosis.||Manipulation of the gland during subtotal thyroidectomy may result in increased hormone release, causing thyroid storm.|
|Evaluate reflexes periodically. Observe for neuromuscular irritability: twitching, numbness, paresthesias, positive Chvostek’s and Trousseau’s signs, seizure activity.||Hypocalcemia with tetany (usually transient) may occur 1–7 days postoperatively and indicates hypoparathyroidism, which can occur as a result of inadvertent trauma to or partial-to-total removal of the parathyroid gland(s) during surgery.|
|Keep side rails raised and padded, bed in a low position, and airway at the bedside. Avoid the use of restraints.||Reduces the potential for injury if seizures occur.|
|Monitor serum calcium levels.||Patients with levels of less than 7.5 mg/100 mL generally require replacement therapy.|
|Administer medications as indicated:|
||Corrects deficiency, which is usually temporary but may be permanent. Note: Use with caution in patients taking digitalis because calcium increases cardiac sensitivity to digitalis, potentiating the risk of toxicity.|
||Helpful in lowering elevated phosphorus levels associated with hypocalcemia.|
||Promotes rest, reducing exogenous stimulation.|
|Controls seizure activity until corrective therapy is successful.|
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
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- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans