5 Thyroidectomy Nursing Care Plans


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:

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

Nursing Care Plans

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.

Here are five (5) nursing care plans and nursing diagnosis for thyroidectomy:

  1. Acute Pain
  2. Risk for Impaired Airway Clearance
  3. Impaired Verbal Communication
  4. Risk for Injury
  5. Deficient Knowledge

Risk for Injury

Nursing Diagnosis

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.

Desired Outcomes

  • Client will demonstrate an absence of injury with complications minimized/controlled.
Nursing Interventions Rationale
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: 
  • Calcium (gluconate, lactate)
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.
  • Phosphate-binding agents
Helpful in lowering elevated phosphorus levels associated with hypocalcemia.
  • Sedatives
Promotes rest, reducing exogenous stimulation.
Controls seizure activity until corrective therapy is successful.

See Also

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Endocrine and Metabolic Care Plans

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