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
Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic.
May be related to
- Lack of exposure/recall, misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; request for information; statement of misconception
- Inaccurate follow-through of instructions/development of preventable complications
- Client will verbalize understanding of surgical procedure and prognosis and potential complications.
- Client will verbalize understanding of therapeutic needs.
- Client will participate in the treatment regimen.
- Client will initiate necessary lifestyle changes.
|Review surgical procedure and future expectations.||Provides knowledge base from which patient can make informed decisions.|
|Discuss the need for a well-balanced, nutritious diet and, when appropriate, inclusion of iodized salt.||Promotes healing and helps the patient regain or maintain an appropriate weight. Use of iodized salt is often sufficient to meet iodine needs unless salt is restricted for other healthcare problems.|
|Recommend avoidance of goitrogenic foods, e.g., excessive ingestion of seafood, soybeans, turnips.||Contraindicated after partial thyroidectomy because these foods inhibit thyroid activity.|
|Identify foods high in calcium and vitamin D.||Maximizes supply and absorption of calcium if the parathyroid function is impaired.|
|Encourage progressive general exercise program.||In patients with subtotal thyroidectomy, exercise can stimulate the thyroid gland and production of hormones, facilitating recovery of general well-being.|
|Review postoperative exercises to be instituted after incision heals: flexion, extension, rotation, and lateral movement of head and neck.||Regular ROM exercises strengthen neck muscles, enhance circulation and healing process.|
|Review importance of rest and relaxation, avoiding stressful situations and emotional outbursts.||Effects of hyperthyroidism usually subside completely, but it takes some time for the body to recover.|
|Instruct in incisional care: cleansing, dressing application.||Enables patient to provide competent self-care.|
|Recommend the use of loose-fitting scarves to cover the scar, avoiding the use of jewelry.||Covers the incision without aggravating healing or precipitating infections of the suture line.|
|Apply cold cream after sutures have been removed.||Softens tissues and may help minimize scarring.|
|Discuss the possibility of a change in voice.||Alteration in vocal cord function may cause changes in pitch and quality of voice, which may be temporary or permanent|
|Review drug therapy and the necessity of continuing even when feeling well.||If thyroid hormone replacement is needed because of surgical removal of the gland, the patient needs to understand the rationale for replacement therapy and the consequences of failure to routinely take medication.|
|Identify signs and symptoms requiring medical evaluation. Watch out for fever, chills, continued or purulent wound drainage, erythema, nausea and vomiting, insomnia, constipation, drowsiness, intolerance to cold, fatigue.||Early recognition of developing complications such as infection, hyperthyroidism, or hypothyroidism may prevent progression to a life-threatening situation. As many as 43% of patients with subtotal thyroidectomy will develop hypothyroidism in time.|
|Stress necessity of continued medical follow-up.||Provides opportunity for evaluating effectiveness of therapy and prevention of complications.|
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