[thyroid + -ectomy]
Excision of the thyroid gland, typically to treat thyroid cancers, goiters, or Graves disease.
Preoperative: The patient is taught about postoperative care measures and pain management.
Postoperative: All general patient care concerns apply. Attention to compromise of the airway by hemorrhage or recurrent laryngeal nerve injury is emphasized. The patient is maintained in a semi-Fowler position, with head and neck well supported to ease incisional tension. A Hemovac, or similar low-suction drain, may be in place for the first 24 to 48 hr. The patient is checked for dysphagia and hoarseness, signs of laryngeal nerve injury, and for bleeding or infection. Evidence of hypocalcemia resulting from unrecognized removal of the parathyroid glands must also be assessed with postoperative parathyroid hormone levels and with physical assessments for tetany. The patient is watched closely for signs of respiratory distress; in the recovery room and the patient care setting, there should be equipment for immediate resuscitation (airway reintubation, tracheostomy tray, or both), various pharmacological agents (such as calcium chloride, antithyroid agents, and antihypertensives). The surgeon must be notified immediately in case problems are suspected. Teaching upon discharge focuses on care of the incision and on signs of infection that must be reported immediately. Regular follow-up care is required to manage hypothyroidism, which develops 2 to 4 weeks after total thyroidectomy, and to assess thyroid size and status following subtotal resection.
CAUTION: The recurrent laryngeal nerve is inadvertently damaged by surgery in more than 1% of operations. This can produce paralysis of the vocal cords.
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