Positioning Nursing Considerations

Note any changes in appetite,

Place patient in a semi-fowler’s
weight, activity level, speech,
position.
memory, skin such as dryness and
Sitting position is angled
cold intolerance
between 15 and 45 degrees.
Administer oral calcium
Support their head and neck using
supplements, magnesium
either sandbags or pillows to keep
supplements and vitamin D as
everything in a neutral position
prescribed
don’t want the patient to
Monitor and assess the patient
hyperextend
every 2 hours for 24 hours for
Keep patient’s head at the
signs and symptoms of
midline
hemorrhage such as irregular
breathing, frequent swallowing,
Pain and Infection Control
blood on wound dressing, neck
Pain after thyroidectomy is reported swelling and pooling of blood
as minimal in patients who had under the neck and shoulder area
preoperative education on the or tracheal compression
procedure Assess the patient’s ability to
Non-opioid and non swallow by doing the water
pharmacological therapies should swallow test and repetitive saliva
be prioritized swallow test
Pain scores to those treated
Patient Teaching
with opioids up to the first
Avoid extreme neck extension or
postoperative visit have similar
flexing, and to keep their head in
pain scores to non-opioid
a midline position.
(acetaminophen & ibuprofen)
treatments.
Reinforce that the patient will POST-OPERATIVE
Application of topical antibiotic
need to take thyroid replacement
THYRODECTOMY CARE
for the rest of their lives
Soframycin: Applied three times a
day to prevent infection
no longer producing thyroid thai·roy·dek·tuh·mee
hormones T3 and T4 anymore the removal of the thyroid
CREATED BY:
Josiah David P. Maraat, SN; Kyrah Mae Nerez, SN Administer Levothyroxine gland and is done to patients
REFERENCES: consistently in the morning on who have a large goiter causing
tracheal compression, lack of
Harding, M. M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis's Medical-Surgical
Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier.
an empty stomach, at least 30
response to antithyroid therapy
Yu, V., & Wu, C. (n.d.). Speech therapy after thyroidectomy - Yu - Gland Surgery. Gland Surgery.

to 60 minutes before food.

Retrieved October 29, 2022, from https://gs.amegroups.com/article/view/15245/html

or thyroid cancer
UpToDate
 Types of Thyroidectomy
1. Total Thyroidectomy
Choice of operation for all types
of thyroid cancer where the
entire thyroid gland is removed
2. Near Total Thyroidectomy
surgical removal of both thyroid
lobes except for a small amount
of thyroid tissue on one or both
sides less than 1.0 mL
3. Subtotal Thyroidectomy
involves removing 90% of the
thyroid gland leaving
approximately 3g-5g on the less
affected side
4. Lobectomy/Hemithyroidectomy
removal of half of the thyroid
gland
Indications
Thyroid Nodules
Hyperthyroidism
Obstructive or substernal
goiter
Cancer
Complications
A. Hypothyroidism
If the entire thyroid gland is removed,
the body can no longer make thyroid
hormone which in return would cause
symptoms of hypothyroidism or an
underactive thyroid such as
decreased mentation, metabolism
and movement
B. Hypocalcemia/ Hypoparathyroidism
A common complication following a
total thyroidectomy where it is
characterized by hypocalcemia due
to a lack of parathyroid hormone to
maintain serum calcium levels
C. Hemorrhage and Hematoma
may occur after surgery and impede
the patient's ability to breathe
causing airway obstruction
D. Recurrent Laryngeal Nerve Injury
Unilateral Vocal Cord Paralysis
Bilateral Vocal Cord Paralysis
E. Dysphagia
F. Horner Syndrome
A neurologic condition causing ptosis,
miosis and anhidrosis
G. Tracheal Injury
may occur due to excessive use of
cautery on or around the trachea
H. Esophageal Injury
Usually the esophagus is not affected
during thyroidectomy however there
is still a percentage of esophageal
injury associated with thyroidectomy
Post-Operative Care
Thyroid Hormone
Supplementation
Supplementation is determined
on the extent of the resection of
the thyroid
Benign disease except
hyperthyroidism
Patients who underwent
total thyroidectomy were
prescribed a daily dose of
thyroid-stimulating
hormone (TSH)
(levothyroxine) 1.6 mcg/kg
body weight after surgery
Thyroid lobectomy
TSH are not routinely
started after surgery
Permanent hypothyroidism should
be discussed with patients prior
to any thyroid surgery, including
thyroid lobectomy
TSH levels should be obtained
approximately six weeks after
surgery to determine the need for
thyroid hormone replacement
Bleeding
Lots of blood flows through the
thyroid gland
Check their wound dressing for
blood, and check behind their
neck to make sure blood is not
pooling behind them