Thyroidectomy- it is a surgical procedure-Removal of thyroid gland

 

Thyroidectomy

Definition:

It is an operation, in which the thyroid gland is removed.

 

Classification

1.Partial thyroidectomy.

2.Subtotal thyroidectomy.

3.Total thyroidectomy.

4.Radical thyroidectomy.

 

Pre-operative care

1.The patient is hospitalized.

2.He is introduced to other patients, who have undergone the same operation successfully. after talking  to them ,his anxiety is relieved.

3.Adequate calories are provided in view of increased metabolic rate of the patient in case of thyrotoxicosis.

4.Carbimazole,neomercazole are stopped 8 to 10 days before the operation.

5.Lugol’s iodine is given 0.3 to 0.9 ml in milk, three times a day,for,10 to  14 days before the operation.

6.Propranolol is given 40 mg 8 hourly orally.

7.Sedative is given before the operation.

8.Digoxin is given for atrial fibrillation.

9.Skin over the neck, lower jaw, chest, axilla ,and arms is shaved and prepared for surgery.

10.See chapter 4 for other preoperative care.

 

Post- operative care

1.See chapter 4 for postoperative  care. Additional features are as follows.

2.The head is supported when the head is lifted, so that there will not be any tension on the sutures.

3.The patient is taught to support his head with his fingers of both hands linked together  behind the head.

4.The patient is asked to speak less, and that too in whisper so as not to strain and cause pain.

5.Any blood or discharge collected in the surgical  wound is removed.

 

Complications

1.Haemorrhage.

2.Infection.

3.Hoarseness of voice: Due to injury to the recurrent laryngeal nerve.

4.Respiratory difficulty: Due to injury to recurrent laryngeal nerve.

5.Tetany:Due to removal of the parathyroid glands.

These patients have to be given  intravenous  injection of calcium gluconate to cure the tetany .Later they need calcium supplements.

6.Thyrotoxic crisis: there are features of severe thyrotoxicosis in 6 to 24 hours after the surgery.

7.Myxoedema:It is due to excessive removal of the thyroid gland, so that there is not sufficient tissue left behind to  produce adequate quantities of thyroid hormone.

8.Bronchopneumonia.