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Thyroidectomy, although rare, may be performed for patients with thyroid cancer, hyperthyroidism,

and drug reactions to anti-thyroid 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.
Types
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.
Contents [show]

Nursing Care Plans


Thyroidectomy requires meticulous postoperative care to prevent complications. Here are 5
thyroidectomy nursing care plans.
Nursing Priorities
1.

Reverse/manage hyperthyroid state preoperatively.

2.

Prevent complications.

3.

Relieve pain.

4.

Provide information about surgical procedure, prognosis, and treatment


needs.

Discharge Goals
1.

Complications prevented/minimized.

2.

Pain alleviated.

3.

Surgical procedure/prognosis and therapeutic regimen understood.

4.

Plan in place to meet needs after discharge.

1. Acute Pain
Nursing Diagnosis

Pain, acute

May be related to

Surgical interruption/manipulation of tissues/muscles

Postoperative edema

Possibly evidenced by

Reports of pain

Narrowed focus; guarding behavior; restlessness

Autonomic responses

Desired Outcomes

Report pain is relieved/controlled.

Demonstrate use of relaxation skills and diversional activities appropriate


to situation.

Nursing Interventions

Rationale

Assess verbal and nonverbal reports of

Useful in evaluating pain, choice of

pain, noting location, intensity (010

interventions, effectiveness of therapy.

scale), and duration.


Place in semi-Fowlers position and

Prevents hyperextension of the neck and

support head and neck with sandbags or

protects integrity of the suture line.

small pillows.
Maintain head and neck in neutral

Prevents stress on the suture line and

position and support during position

reduces muscle tension.

changes. Instruct patient to use hands to


support neck during movement and to
avoid hyperextension of neck.
Keep call bell and frequently needed

Limits stretching, muscle strain in

items within easy reach.

operative area.

Give cool liquids or soft foods, such as

Although both may be soothing to sore

Nursing Interventions

Rationale

ice cream or popsicles.

throat, soft foods may be tolerated better


than liquids if patient experiences
difficulty swallowing.

Encourage patient to use relaxation

Helps refocus attention and assists patient

techniques: guided imagery, soft music,

to manage pain and/or discomfort more

progressive relaxation.

effectively.

Administer analgesics and/or analgesic

Reduces pain and discomfort; enhances

throat sprays and lozenges as necessary.

rest.

Provide ice collar if indicated.

Reduces tissue edema and decreases


perception of pain.

2. Ineffective Airway Clearance


Nursing Diagnosis

Risk for Ineffective Airway Clearance

Risk factors may include

Tracheal obstruction; swelling, bleeding, laryngeal spasms

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

Maintain patent airway, with aspiration prevented.

Nursing Interventions

Rationale

Monitor respiratory rate, depth, and work

Respirations may remain somewhat rapid,

of breathing.

but development of respiratory distress is

Nursing Interventions

Rationale
indicative of tracheal compression from
edema or hemorrhage

Auscultate breath sounds, noting presence

Rhonchi may indicate airway obstruction

of rhonchi.

and accumulation of copious thick


secretions.

Assess for dyspnea, stridor, crowing,

Indicators of tracheal obstruction and

and cyanosis. Note quality of voice.

laryngeal spasm, requiring prompt


evaluation and intervention.

Caution patient to avoid bending neck;

Reduces likelihood of tension on surgical

support head with pillows.

wound.

Assist with repositioning, deep breathing

Maintains clear airway and ventilation.

exercises, and/or coughing as indicated.

Although routine coughing is not


encouraged and may be painful, it may be
needed to clear secretions.

Suction mouth and trachea as indicated,

Edema and pain may impair patients

noting color and characteristics of

ability to clear own airway.

sputum.
Check dressing frequently, especially

If bleeding occurs, anterior dressing may

posterior portion.

appear dry because blood pools


dependently.

Investigate reports of difficulty

May indicate edema or sequestered

swallowing, drooling of oral secretions.

bleeding in tissues surrounding operative


site.

Keep tracheostomy tray at bedside.

Compromised airway may create a life-

Nursing Interventions

Rationale
threatening situation requiring emergency
procedure.

Provide steam inhalation; humidify room

Reduces discomfort of sore throat and

air.

tissue edema and promotes expectoration


of secretions.

Assist with procedures: Tracheostomy,

May be necessary to maintain airway if

return to surgery.

obstructed by edema of glottis or


hemorrhage. Returning to operating room
may require ligation of bleeding vessels.

3. Impaired Verbal Communication


Nursing Diagnosis

Communication, impaired verbal

May be related to

Vocal cord injury/laryngeal nerve damage

Tissue edema; pain/discomfort

Possibly evidenced by

Impaired articulation, does not/cannot speak; use of nonverbal cues such


as gestures

Desired Outcomes

Establish method of communication in which needs can be understood.

Nursing Interventions

Rationale

Assess speech periodically. Encourage

Hoarseness and sore throat may occur

voice rest.

secondary to tissue edema or surgical


damage to recurrent laryngeal nerve and
may last several days. Permanent nerve

Nursing Interventions

Rationale
damage can occur (rare) that causes
paralysis of vocal cords and/or
compression of the trachea.

Keep communication simple. Ask yes or

Reduces demand for response and

no questions.

promotes voice rest.

Provide alternative methods of

Facilitates expression of needs.

communication as appropriate: slate


board, picture board. Place IV line to
minimize interference with written
communication.
Anticipate needs as possible. Visit patient

Reduces anxiety and patients need to

frequently.

communicate.

Post notice of patients voice limitations

Prevents patient from straining voice to

at central station and answer call bell

make needs known or summon assistance.

promptly.
Maintain quiet environment.

Enhances ability to hear whispered


communication and reduces necessity for
patient to raise or strain voice to be heard.

4. Risk for Injury


Nursing Diagnosis

Injury, risk for [tetany]

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

Demonstrate absence of injury with complications minimized/controlled.

Nursing Interventions

Rationale

Monitor vital signs noting elevating

Manipulation of gland during subtotal

temperature, tachycardia, arrhythmias,

thyroidectomy may result in increased

respiratory distress, cyanosis.

hormone release, causing thyroid storm.

Evaluate reflexes periodically. Observe

Hypocalcemia with tetany (usually

for neuromuscular irritability: twitching,

transient) may occur 17 days

numbness, paresthesias, positive

postoperatively and indicates

Chvosteks and Trousseaus signs, seizure

hypoparathyroidism, which can occur as a

activity.

result of inadvertent trauma to or partialto-total removal of parathyroid gland(s)


during surgery.

Keep side rails raised and padded, bed in

Reduces potential for injury if seizures

low position, and airway at bedside.

occur.

Avoid use of restraints.


Monitor serum calcium levels.

Patients with levels 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

Nursing Interventions

Rationale
digitalis because calcium increases
cardiac sensitivity to digitalis,
potentiating risk of toxicity.

Phosphate-binding agents

Helpful in lowering elevated phosphorus


levels associated with hypocalcemia.

Sedatives

Promotes rest, reducing exogenous


stimulation.

Anticonvulsants

Controls seizure activity until corrective


therapy is successful.

5. Knowledge Deficit
Nursing Diagnosis

Knowledge, deficient [Learning Need] regarding condition, prognosis,


treatment, self-care, and discharge needs

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

Desired Outcomes

Verbalize understanding of surgical procedure and prognosis and potential


complications.

Verbalize understanding of therapeutic needs.

Participate in treatment regimen.

Initiate necessary lifestyle changes.

Nursing Interventions

Rationale

Review surgical procedure and future

Provides knowledge base from which

expectations.

patient can make informed decisions.

Discuss need for well-balanced, nutritious

Promotes healing and helps patient regain

diet and, when appropriate, inclusion of

or maintain appropriate weight. Use of

iodized salt.

iodized salt is often sufficient to meet


iodine needs unless salt is restricted for
other healthcare problems.

Recommend avoidance of goitrogenic

Contraindicated after partial

foods, e.g., excessive ingestion of

thyroidectomy because these foods inhibit

seafood, soybeans, turnips.

thyroid activity.

Identify foods high in calcium and

Maximizes supply and absorption of

vitamin D.

calcium if parathyroid function is


impaired.

Encourage progressive general exercise

In patients with subtotal thyroidectomy,

program.

exercise can stimulate the thyroid gland


and production of hormones, facilitating
recovery of general well-being.

Review postoperative exercises to be

Regular ROM exercises strengthen neck

instituted after incision heals: flexion,

muscles, enhance circulation and healing

extension, rotation, and lateral movement

process.

of head and neck.


Review importance of rest and relaxation,

Effects of hyperthyroidism usually

avoiding stressful situations and

subside completely, but it takes some time

emotional outbursts.

for the body to recover.

Nursing Interventions

Rationale

Instruct in incisional care: cleansing,

Enables patient to provide competent self-

dressing application.

care.

Recommend the use of loose-fitting

Covers the incision without aggravating

scarves to cover scar, avoiding the use of

healing or precipitating infections of

jewelry.

suture line.

Apply cold cream after sutures have been

Softens tissues and may help minimize

removed.

scarring.

Discuss possibility of 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

If thyroid hormone replacement is needed

continuing even when feeling well.

because of surgical removal of gland,


patient needs to understand rationale for
replacement therapy and consequences of
failure to routinely take medication.

Identify signs and symptoms requiring

Early recognition of developing

medical evaluation. Watch out for fever,

complications such as infection,

chills, continued or purulent wound

hyperthyroidism, or hypothyroidism may

drainage, erythema, nausea and vomiting,

prevent progression to life-threatening

insomnia, constipation, drowsiness,

situation. As many as 43% of patients

intolerance to cold, fatigue.

with subtotal thyroidectomy will develop


hypothyroidism in time.

Stress necessity of continued medical

Provides opportunity for evaluating

follow-up.

effectiveness of therapy and prevention of

Nursing Interventions

Rationale
complications.

Other Possible Nursing Care Plan

Risk for head or neck traumarisk factors may include loss of muscle
control or support and position of suture line.