THYROIDECTOMY

BY: JUVIE LIE F. FERREN, SN

BSN 3 OLMM
DEFINITION
• Thyroidectomy is the removal of all or part of your
thyroid gland. Your thyroid is a butterfly-shaped gland
located at the base of your neck. It produces
hormones that regulate every aspect of your
metabolism, from your heart rate to how quickly you
burn calories.
• Thyroidectomy is used to treat thyroid disorders, such
as cancer, noncancerous enlargement of the thyroid
(goiter) and overactive thyroid (hyperthyroidism).
• How much of your thyroid gland is removed during
thyroidectomy depends on the reason for surgery. If
only a portion is removed (partial thyroidectomy),
your thyroid may be able to function normally after
surgery. If your entire thyroid is removed (total
thyroidectomy), you need daily treatment with
thyroid hormone to replace your thyroid's natural
function.
 ANATOMY AND PHYSIOLOGY
• The endocrine system exerts chemical control
over the human body by maintaining the body’s
internal environment within certain narrow
ranges.
• The endocrine system, this is know as
homeostasis. This maintenance of homeostasis,
which involves growth, maturation,
reproduction, metabolism and human behavior,
is shared by both the endocrine system and
nervous system in a unique partnership
• They are ductless glands that secret their
hormone directly into the bloodstream
• A butterfly-shaped organ, the thyroid gland is
located anterior to the trachea, just inferior to
the larynx. The medial region, called the
isthmus, is flanked by wing-shaped left and
right lobes. Each of the thyroid lobes are
embedded with parathyroid glands, primarily
on their posterior surfaces. The tissue of the
thyroid gland is composed mostly of thyroid
follicles. The follicles are made up of a central
cavity filled with a sticky fluid called colloid.
Surrounded by a wall of epithelial follicle cells,
the colloid is the center of thyroid hormone
production, and that production is dependent
on the hormones’ essential and unique
component: iodine.
TYPES OF THYROIDECTOMY
• Hemithyroidectomy
• Subtotal thyroidectomy
• Partial thyroidectomy
• Near total thyroidectomy
• Total thyroidectomy
• Hartley Dunhill operation
• Hemithyroidectomy—Entire isthmus is removed along with 1
lobe. Done in benign diseases of only 1 lobe.
• Subtotal thyroidectomy—Removal of majority of both
lobes leaving behind 4-5 grams (equivalent to the size of a
normal thyroid gland) of thyroid tissue on one or both
sides—this used to be the most common operation for
multinodular goiter.
• Partial thyroidectomy—Removal of gland in front of
trachea after mobilization. Done in nontoxic MNG. Its role
is controversial.
• Near total thyroidectomy—Both lobes are removed except
for a small amount of thyroid tissue (on one or both sides)
in the vicinity of the recurrent laryngeal nerve entry point
and the superior parathyroid gland.
• Total thyroidectomy—Entire gland is removed. Done in
cases of papillary or follicular carcinoma of thyroid,
medullary carcinoma of thyroid. This is now also the most
common operation for multinodular goiter.
• Hartley Dunhill operation—Removal of 1 entire lateral
lobe with isthmus and partial/subtotal removal of
opposite lateral lobe. Done in nontoxic MNG.
ETIOLOGY/INDICATION

A thyroidectomy may be recommended for conditions such as:

• Thyroid cancer. Cancer is the most common reason for
thyroidectomy. If you have thyroid cancer, removing most, if
not all, of your thyroid will likely be a treatment option.
• Noncancerous enlargement of the thyroid (goiter). Removing
all or part of your thyroid gland is an option if you have a large
goiter that is uncomfortable or causes difficulty breathing or
swallowing or, in some cases, if the goiter is causing
hyperthyroidism.
• Overactive thyroid (hyperthyroidism). Hyperthyroidism is
a condition in which your thyroid gland produces too
much of the hormone thyroxine. If you have problems
with anti-thyroid drugs and don't want radioactive iodine
therapy, thyroidectomy may be an option.
• Indeterminate or suspicious thyroid nodules. Some
thyroid nodules can't be identified as cancerous or
noncancerous after testing a sample from a needle biopsy.
Doctors may recommend that people with these nodules
have thyroidectomy if the nodules have an increased risk
of being cancerous.
SIGNS AND SYMPTOMS

The patients have compressive symptoms including;

• Dysphagia
• Dyspnea
• Hoarseness due to a large goiter
• Lump and swelling in the neck
PROGNOSIS
• Thyroid Cancer Prognosis
• Most thyroid cancers are very curable. In fact, the most common types
of thyroid cancer (papillary and follicular thyroid cancer) are the most
curable. In younger patients, less than 50 years of age, both papillary
and follicular cancers have a more than 98% cure rate if treated
appropriately. Both papillary and follicular thyroid cancers are typically
treated with at least complete removal of the lobe of the thyroid gland
that harbors cancer.  A thyroid gland that has a thyroid cancer nodule
within it and has multiple other nodules in both sides of the thyroid or
when cancer has spread to lymph nodes in the neck is a clear indication
for complete removal of the thyroid gland. 
• Only expert thyroid surgeons
should perform thyroid surgery
for nodules that may be
cancers or patients with known
thyroid malignancy.  When
expert evaluation of patients
with thyroid nodules and
cancers combined with expert
thyroid surgery provides
patients with the best
outcomes. 
DIAGNOSTIC PROCEDURE

• Physical exam. The doctor will

examine the neck to feel for
physical changes in the
thyroid, such as thyroid
nodules. He or she may also
ask about your risk factors,
such as past exposure to
radiation and a family history
of thyroid tumors.
• Blood tests. Blood tests help determine
if the thyroid gland is functioning
normally.
• Ultrasound imaging. Ultrasound uses
high-frequency sound waves to create
pictures of body structures. To create an
image of the thyroid, the ultrasound
transducer is placed on your lower neck.
The appearance of the thyroid on the
ultrasound helps your doctor determine
whether a thyroid nodule is likely to be
noncancerous (benign) or whether
there's a risk that it might be cancerous.
• Removing a sample of thyroid
tissue. During a fine-needle
aspiration biopsy, the doctor inserts a
long, thin needle through the skin
and into the thyroid nodule.
Ultrasound imaging is typically used
to precisely guide the needle into the
nodule. The doctor uses the needle
to remove samples of suspicious
thyroid tissue. The sample is
analyzed in the laboratory to look for
cancer cells.
• Other imaging tests. You may have one or more imaging tests to
help your doctor determine whether your cancer has spread
beyond the thyroid. Imaging tests may include CT, MRI and nuclear
imaging tests that use a radioactive form of iodine.
• Genetic testing. Some people with medullary thyroid cancer may
have genetic changes that can be associated with other endocrine
cancers. Your family history may prompt your doctor to
recommend genetic testing to look for genes that increase your
risk of cancer.
NURSING INTERVENTION
VIDEO
PRE OP CARE
• Administer ordered antithyroid medications and iodine
preparations and monitor for side effects
• Assess voice quality to obtain baseline
• Teach patient to support neck by placing both hands behind neck
when sitting up in bed, moving, and coughing
• Obtain baseline laboratory tests such as: CBC, thyroid hormone
levels, serum calcium, and phosphorous concentrations
• Allow patient to verbalize concerns regarding surgical procedure
• Provide appropriate interventions to help alleviate stress and
anxiety
INTRA OP CARE

• Identifies patient, check patients chart and consent for surgery

• Maintains/ensures asepsis inside the OR
• Prepares the instrument, ensuring its completeness, and keeps
them as clean as possible (sterile)
• Ensures safety of patient by restrains during and after the
induction of anesthesia and etc.
• Responsible for the specimen and after care of it
• Cleans the OR, patient before bringing back to recovery room
POST OP CARE
COMPLICATIO
NS
Thyroidectomy is a common surgical
procedure that has several potential
complications or sequelae including:
• Temporary or permanent change in
voice
• Temporary or permanently low
calcium
• Need for lifelong thyroid hormone
replacement
• Bleeding
• Wound Infection
• Thyroid storm or Thyrotoxic crisis
• The remote possibility of airway
obstruction due to bilateral vocal
cord paralysis.