1. It is an operation that involves the surgical removal of all or a part of the thyroid gland
Thyroidectomy

3. The Thyroid Gland
The thyroid is an endocrine gland located at the front of the neck below the larynx and around the trachea.
Iodine, an element found in many foods, is taken up by the thyroid to produce thyroid hormone. 
Thyroid disorders are very common. Although small, the thyroid plays a large role in producing hormones that every cell in our body relies on for the proper conversion of calories and oxygen to energy. 
Color – brownish red due to increase blood supply
Nerves important for voice pass through thyroid

4. In other words, metabolism regulation is dependent on thyroid function and the condition of thyroid gland. 
This gland secretes essential hormones called thyroid hormones that are responsible for proper growth and development, balanced metabolism, and proper regulation of body’s temperature.
Many people have an undiagnosed thyroid problem
Women are especially at risk for having unrecognized thyroid problems especially if they have a history of diabetes, rheumatoid arthritis, pernicious anemia, or other autoimmune disease

5. Thyroid hormones
The two kinds of thyroid hormones made are Thyroxine, also known as T4, and Triiodothyronine or T3
The thyroid gland makes and stores hormones that help regulate the heart rate, blood pressure, body temperature, and metabolism
Thyroid hormones are essential for the function of the body
Thyroid hormones help regulate growth and metabolism

6. Calcium Absorption
The body absorbs calcium from ingested food. Good sources of calcium include milk, yogurt, ice cream.
The thyroid and parathyroid glands regulate blood calcium.
When blood calcium is low, the parathyroid glands release parathyroid hormone, which breaks down bone to release calcium into the blood.
When blood calcium is high, the thyroid gland releases calcitonin, which reduces the levels of calcium in the blood. Vitamin D facilitates intestinal calcium absorption, and the action of parathyroid hormone, produced by the parathyroid gland, enhances it. Parathyroid hormone also stimulates calcium reabsorption from the kidneys, but high blood calcium results in increased calcium excretion.

7. Indications Cancer of thyroid
Toxic thyroid nodule – produce too much thyroid hormone
Multi nodular goiter
Thyroid nodule (if FNA results are unclear)
Disease conditions of thyroid gland – hyperthyroidism or goiter, graves disease (autoimmune disease commonly affects thyroid)
Symptomatic obstruction – causing difficulties in swallowing or breathing
Cosmetic – very enlarged thyroid

8. Complications Temporary or permanent change in voice
Temporary or permanently low calcium
Need life long thyroid hormone replacement
Bleeding, Infection
Possibility of airway obstruction due to vocal cord paralysis
Hypothyroidism

9. Laryngeal nerve injury (Difficulty speaking, Difficulty swallowing, Hoarseness)
Unilateral damage results in a hoarse voice. Recurrent laryngeal nerve injury may occur during the ligature of the inferior thyroid artery
Hypoparathyroidism
Anesthetic complications
Infection, stitch granuloma, chyle leak, heamorrhage/hematoma (can compress the airway and become life threatening)
Complications are uncommon when an experienced surgeon performed the surgery

10. Types Thyroid lobectomy Subtotal thyroidectomy Total thyroidectomy
Near total thyroidectomy
Isthmectomy
Hartley dunhill operation

11. Subtotal thyroidectomy or Partial thyroidectomy – major part is removed or partial removal of thyroid gland
Total thyroidectomy – entire gland is removed

12. Near total thyroidectomy - both lobes are removed except for a small amount of thyroid tissue
Hartley dunhill operation - removal of one entire lateral lobe with isthmus and partial / subtotal removal of opposite lateral lobe
Isthemectomy – removing the band tissue (isthmus) connecting the two lobes of the thyroid

13. Pre operative care
Administer ordered antithyroid medications and iodine preparations, and monitor their effects.
These drugs promote a euthyroid state.
Iodine preparations are given to the client before the surgery to decrease vascularity of the gland and there by decreasing the risk of hemorrhage

14. Teach the patient to support the neck by placing both hands behind the neck when sitting up in bed, while moving about, and while coughing.
Placing the hands behind the neck provides support for the suture line

15. Answer questions, and allow time for the client to verbalize properly
Because the incision is made at the base of the throat and clients are often concerned about their appearance after surgery
Explain that the scar will eventually be only a thin line and that jewelry may used to cover it

16. Care of a patient after thyroid surgery
Provide comfort measures
Administer analgesic pain medications as ordered and monitor their effectiveness
Place the client in a semi-fowler’s position after recovery from anesthesia (this will decrease the strain on the suture line)
Support the head and neck with pillows

17. Monitor for and report signs of complications
Laryngeal nerve damage, hoarseness, weak voice
Assess for the ability to speak aloud, noting quality and tone of voice
The location of the laryngeal nerve increases the risk of damage during thyroid surgery
Hoarseness may be due to edema.

18. Hemorrhage or tissue swelling
Bleeding on dressing, check back of dressing by slipping hand gently under neck and shoulders
Monitor blood pressure and pulse for symptoms of hypovolemic shock
Choking sensation
The danger of hemorrhage is greatest in the first hours after surgery
Difficulty in coughing or swallowing
Sensation of dressing being too tight even after it is loosened

19. Hypocalcemia (tetany)
Assess for signs of calcium deficiency including tingling of toes, fingers and lips, muscular twitches, positive chovstek’s and trousseau’s signs, seizures and decreased serum calcium levels
Keep calcium gluconate or calcium chloride available for immediate intravenous use if necessary.
The parathyroid glands are located in and near the thyroid gland, surgery of the thyroid gland may injure or remove parathyroid glands, resulting in tetany. Tetany may occur in 1-7 days after thyroidectomy

20. positive chovstek’s sign
This is the abnormal reaction due to the stimulation of facial nerve. When facial nerve is tapped at the angle of the jaw, the facial muscles on the same side of the face will contract along with twitch of the nose or lips

21. Respiratory distress (this can be due to hemorrhage and edema which may compress the trachea or due to damage of laryngeal nerve causing spasms of vocal cords)
Assess the respiratory rate, rhythm, depth and effort
Maintain humidification as ordered
Assist the client with coughing and deep breathing
Have suction equipment, oxygen and Tracheostomy set available for immediate use

22. For acute respiratory distress
Call for immediate medical help
Raise head end of the bed
Loosen dressing over incision
Give calcium as ordered, if signs and symptoms of tetany are present
If loosening the dressing does not relieve symptoms of respiratory distress and if medical help is not readily available, remove clips or sutures as instructed

23. Provide emergency care
Keep emergency supplies readily available
Tracheostomy set (for laryngeal nerve damage), oxygen and suction equipment, suture removal set (for respiratory obstruction from hemorrhage)
Intravenous calcium gluconate or calcium chloride

24. Maintain nutritional status
Start soft foods as soon as tolerated (only fluids may be tolerated initially)
Encourage a high carbohydrate, high protein diet

25. Teach patient
Range of motion exercises for neck when suture line is healed to prevent permanent limitations
Need for lifelong thyroid hormone replacement therapy after a total thyroidectomy
Follow up care