THYROIDECTOMY

A. General information
1. Partial or total removal of the thyroid gland
2. Indications
a. Subtotal thyroidectomy: hyperthyroidism
b. Total thyroidectomy: thyroid cancer
B. Nursing interventions: preoperative
1. Ensure that the client is adequately prepared for surgery
a. Cardiac status is stable
b. Weight and nutritional status are normal
2. Administer antithyroid drugs as ordered to suppress the
production and secretion of thyroid hormone and to prevent
thyroid storm
3. Administer iodine preparations (Lugol’s or potassium iodide
solution) to reduce the size Vascularity of the gland and prevent
hemorrhage
C. Nursing interventions: postoperative
1. Monitor vital signs and I&O
2. Check the dressings for signs of hemorrhage; check for wetness
behind neck
3. Place client in semi-Fowler’s position and support head with
pillows
4. Observe for respiratory distress secondary to hemorrhage,
edema of the glottis, laryngeal nerve damage, or tetany; keep
tracheostomy set, oxygen, and suction nearby
5. Assess for signs of tetany due to hypocalcemia secondary to
accidental removal of parathyroid glands; keep calcium
gluconate available (see hypoparathyroidism)
6. Encourage the client to rest voice
a. Some hoarseness is common
b. Check every 30-60 minutes for extreme hoarseness or any accompanying respiratory distress
7. Observe for thyroid storm due to release of excessive amounts of thyroid hormone during surgery
8. Administer IV fluids as ordered until the client is tolerating fluids by mouth
9. Administer analgesics as ordered for incisional pain
10. Relieve discomfort from sore throat
a. Cool mist humidifier to thin secretions
b. Administer analgesic throat lozenges before meals and prn as ordered
c. Encourage fluids
11. Encourage coughing and deep breathing every hour
12. Assist the client with ambulation: instruct the client to place hands behind neck to decrease stress on suture line if added support
necessary
13. Provide client teaching and discharge planning concerning
a. Signs and symptoms of hypothyroidism/hyperthyroidism
b. Self-administration of thyroid hormones if total thyroidectomy performed
c. Application of lubricant to incision once sutures are removed
d. Performance of ROM neck exercises 3-4 times a day

Care for the client following a thyroidectomy

a. Observe for signs of respiratory distress and laryngeal stridor caused by tracheal edema (keep tracheotomy set available)
b. Provide humidity with cold steam nebulizer to keep secretions moist when at home
c. Keep the bed in a semi-Fowler’s position
d. Observe dressings at the operative site and back of the neck and shoulders for signs of hemorrhage
e. Observe for signs of thyroid storm such as high fever, tachycardia, irritability, delirium, coma; may result from manipulation of
the gland during surgery, which releases thyroid hormone into bloodstream
f. Notify the physician immediately if signs of thyroid storm occur; administer propanolol (Inderal), iodides, propylthiouracil, and
steroids as ordered
g. Observe for signs of tetany such as numbness or twitching of extremities, spasm of the glottis
h. Hypocalcemia can occur after accidental trauma or removal of the parathyroid glands; if tetany occurs, give calcium gluconate or
calcium chloride (IV) as prescribed
i. Assess for hoarseness; may result from endotracheal intubation or laryngeal nerve damage

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