PHILIPPINE COLLEGE OF HEALTH SCIENCES

Thyroidectomy
OR FINAL REQUIREMENT

Mr. Antonio Valera III

Professor

Submitted by:

Amelee Grace Ting Yu

What is surgery? Surgery is a branch of medicine concerned with disease or conditions requiring or amenable to operative or manual procedure.

What are the responsibilities of a scrub nurse and a circulating nurse? A. Scrub nurse Scrub nurses are fully sterilized with special soap and sterile garments because they work side by side with the surgical team. A scrub nurse hands the surgical equipment to the surgeon and helps monitor the patients health during procedures. Scrub nurses, especially ones with a broad experience in different procedures, are highly sought-after members of the surgical team. A scrub nurse is a person with the stamina to be able to assist during long surgical procedures. Patient care is an essential role B. Circulating nurse The circulating nurse's responsibilities include arranging the operating room, gathering all of the supplies needed for the surgery, ties the gowns for the scrub nurse and the surgeon as well as providing scrub personnel with stools as needed during long procedures. The circulating nurse also serves as the patient advocate during the procedure when they are unable to care for themselves. The circulating nurse will check the patients condition before, during and after the procedure to ensure a successful result. The circulating nurse is also essential in proper management of the operating room. A circulating nurse is a person with an acute attention to detail. Strong stamina is also critical because they are on their feet in the operating room for hours at a time.

What are the instruments/supplies that are used for thyroidectomy? Sponge holder, Pick up forcep, square packing ring, army navy retractors, Addison, Addison toothed, ochners, #3 knife handles and #7 knife handles (2nd knife), blades (#10, #15), #4 knife handle (first knife/skin), blades (#20), straight mayo scissors,large towel clips, nylon needle holder, towel clips, baby metzenbaum scissors, regular metzenbaum scissors, forceps, ochners, straight mosquito clamps, curved mosquito clamps, babcock clamps, senn rakes, double skin hooks, single skin hooks, vein retractors, Richardson retractors, bullets (peanuts), sponges, allis, mixter, carmalt, thumb forceps, long thumb, suture scissor, Kelly curved, kelly straight, cherry, folded towel

What is thyroidectomy? A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequela including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction

due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon. The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3), and calcitonin. After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone levothyroxine (Synthroid) - to preventhypothyroidism.

What is the anatomy of the thyroid gland/thyroid? The thyroid gland or simply, the thyroid, in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage (which forms the laryngeal prominence, or "Adam's apple"). The isthmus (the bridge between the two lobes of the thyroid) is located inferior to the cricoid cartilage. The thyroid gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body is to otherhormones. It participates in these processes by producing thyroid hormones, the principal ones being triiodothyronine (T3) andthyroxine which can sometimes be referred to as tetraiodothyronine (T4). These hormones regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. T3 and T4 are synthesized from both iodine and tyrosine. The thyroid also produces calcitonin, which plays a role in calcium homeostasis. Hormonal output from the thyroid is regulated by thyroid-stimulating hormone (TSH) produced by the anterior pituitary, which itself is regulated by thyrotropin-releasing hormone (TRH) produced by the hypothalamus. The thyroid gets its name from the Greek word for "shield", due to the shape of the related thyroid cartilage. The most common problems of the thyroid gland consist of an overactive thyroid gland, referred to as hyperthyroidism, and an underactive thyroid gland, referred to as hypothyroidism. The thyroid gland is a butterfly-shaped organ and is composed of two cone-like lobes or wings, lobus dexter (right lobe) and lobus sinister (left lobe), connected via the isthmus. The organ is situated on the anterior side of the neck, lying against and around the larynx and trachea, reaching posteriorly the oesophagus and carotid sheath. It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence, or 'Adam's Apple'), and extends inferiorly to approximately the fifth or sixth tracheal ring. It is difficult to demarcate the gland's upper and lower border with vertebral levels because it moves position in relation to these during swallowing.

The thyroid gland is covered by a thin fibrous sheath, the capsula glandulae thyroidea, composed of an internal and external layer. The external layer is anteriorly continuous with the lamina pretrachealis fasciae cervicalis and posteriorolaterally continuous with the carotid sheath. The gland is covered anteriorly with infrahyoid muscles and laterally with the sternocleidomastoid muscle also known as sternomastoid muscle. On the posterior side, the gland is fixed to the cricoid and tracheal cartilage and cricopharyngeus muscle by a thickening of the fascia to form the posterior suspensory ligament of Berry. The thyroid gland's firm attachment to the underlying trachea is the reason behind its movement with swallowing. In variable extent, Lalouette's Pyramid, a pyramidal extension of the thyroid lobe, is present at the most anterior side of the lobe. In this region, the recurrent laryngeal nerve and the inferior thyroid artery pass next to or in the ligament and tubercle. Between the two layers of the capsule and on the posterior side of the lobes, there are on each side two parathyroid glands. The thyroid isthmus is variable in presence and size, can change shape and size, and can encompass a cranially extending pyramid lobe (lobus pyramidalis or processus pyramidalis), remnant of the thyroglossal duct. The thyroid is one of the larger endocrine glands, weighing 2-3 grams in neonates and 18-60 grams in adults, and is increased in pregnancy. The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of the external carotid artery, and the inferior thyroid artery, a branch of the thyrocervical trunk, and sometimes by the thyroid ima artery, branching directly from the subclavian artery. The venous blood is drained via superior thyroid veins, draining in the internal jugular vein, and via inferior thyroid veins, draining via the plexus thyroideus impar in the left brachiocephalic vein. Lymphatic drainage passes frequently the lateral deep cervical lymph nodes and the pre- and parathracheal lymph nodes. The gland is supplied by parasympathetic nerve input from the superior laryngeal nerve and the recurrent laryngeal nerve.

How is the surgical procedure done? Thyroid surgical procedures begin with the insertion of an endotracheal tube, followed by the administration of general anesthesia. Once the anesthesia takes effect, the procedure begins with an incision 2 inches to 4 inches long that stretches horizontally over the thyroid. Based on the tests performed before the procedure and the appearance of the thyroid, the final determination of how much of the thyroid should be removed is made. At this point, the portion or portions of the thyroid are removed using a scalpel. Special care is taken not to harm or disturb the parathyroid glands and the vocal cords, both of which rest in the neck near the thyroid. A biopsy may also be done to examine the tissues of the thyroid, the parathyroid and, in rare cases, nearby lymph nodes. This is done to make sure that the portion of the thyroid that is left, if any, is not diseased. In some cases, the tissue is examined by a pathologist immediately, so that a second surgery to remove a diseased portion of the thyroid is not necessary.

Once the thyroid has been removed and any necessary samples have been taken, the area is examined for bleeding. Once the surgeon is confident that there is no bleeding present, the incision is closed. It may be closed with staples or sutures, and in some cases, a surgical drain may be placed to remove fluid from the area in the days after surgery. Once a sterile bandage is applied to the incision, the surgery is completed. Anesthesia is discontinued and medication is given to wake the patient. The patient is then taken to the recovery room to be closely monitored while the remaining anesthetic wears off. After your thyroid surgery, you will be taken to the recovery room. It is normal to feel some pain in your neck after a thyroid procedure. Your throat may also be sore, and it may hurt to talk and swallow. This is normal immediately following the procedure. In most cases, you will stay in the hospital for the first night of your recovery to be monitored for any complications, such as bleeding or difficulty breathing. Initially, you will be limited to taking fluids. If you are able to drink fluids without a problem, you will probably begin eating soft foods the next morning. In most cases, you will be able to return to a normal diet within 72 hours of surgery, barring any unforeseen complications. Most patients are able to return home within 24 hours after the procedure. Before your discharge, you will be given instructions on how to care for your surgical incision and when to see your surgeon. After surgery to remove your thyroid, your body will no longer produce necessary thyroid hormones. These hormones will be replaced with hormone replacement drugs. While synthroid is a particular type of thyroid hormone replacement, you may find that people refer to the entire category of thyroid replacement drugs as synthroid. Your thyroid replacement may begin immediately after your surgery or it may be started several weeks later, depending upon the condition that made the surgery necessary. Once the hormone replacement is started, it will need to be closely monitored to prevent the symptoms of hyper or hypothyroidism. The level of calcium and vitamin D in your blood may also be monitored. In some cases, a daily supplement will be necessary every day. This is especially true if the parathyroid glands were involved in the procedure. Once the medication is dosed properly, you should begin to feel a normal level of energy. Symptoms of ongoing lethargy, fatigue and feeling chronically tired should be reported to the physician managing your thyroid-replacement medication. If you experience ongoing problems with your voice or hoarseness after surgery, let your physician know. While these side effects are normal immediately after surgery, they should resolve during the recovery process.