Trajada, Domingo, Jr., M.

Thyroidectomy
Definition

Removal of all or a portion of the thyroid gland.

Discussion Types 1. Hemithyroidectomy - entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe. 2. Subtotal thyroidectomy - done in toxic thyroid. primary or secondary and also for toxic MNG 3. Partial thyroidectomy - removal of gland in front of trachea after mobilization. It is done in nontoxic MNG. role is controversial. 4. 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. 5. Total thyroidectomy- Entire gland is removed. Done in case of follicular carcinoma of thyroid, medullary ca of thyroid. 6. Hartley Dunhill operation- removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. It is done in non toxic MNG.

Indication A thyroidectomy may be recommended for conditions such as: Malignancy (see Thyroid neoplasm) Cosmetic reasons Goiter which is untreatable by medical methods Severe hyperthyroidism refractory to conservative treatment Orbitopathy in Graves' disease Removal and evaluation of a thyroid nodule whose FNAC results are unclear

 Risk Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy carries a risk of complications. 1. Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years 2. Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery. 3. Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients 4. Anesthetic complications 5. Infection 6. Stitch granuloma 7. Chyle leak 8. Haemorrhage/Hematoma o This may compress the airway, becoming life-threatening. 9. Surgical scar/keloid 10. Removal or devascularization of the parathyroids. 11. Thyroid storm in operations performed for hyperthyroidism Position

Supine with rolled towel or sandbag between the scapulae, hyperextending the neck. If table is placed in reverse Trendelenberg position, a padded foot board should be used to prevent the patient from slipping down toward the end of the table.

Pack/ Drapes

Laparotomy pack with small fenestrated sheet Rolled sheet/ towels

Instrumentation

Major Lap tray Thyroid tray Lahey clamps Spring retractor

Supplies/ Equipment

Basin set Suction

Blades Needle counter Dissector sponge Small drain Solutions Sutures

Procedure Overview 1. The incision is made above the sternal notch. 2. The platysma muscle is incised and retracted. 3. The strap muscles are separated or divided, and blunt and sharp dissections are employed until the thyroid is exposed. 4. The gland is then mobilized, and all or part is removed depending on the involved pathology. 5. Hemostasis is obtained, and the wound is irrigated with warm saline. 6. A drain may be inserted, and the incision is closed in layers by an interrupted method. Perioperative Nursing Consideration 1. The surgeon may request a fine silk suture to use to mark the incision line. 2. The dressing is usually secured by a thyroid collar using a towel folded in thirds lengthwise. The towel is placed around the neck and crisscrossed in front, then fastened with tape. 3. The scrub person should maintain the sterility of the back table/ Mayo until the patient is extubated and breathing is stabilized. 4. An emergency tracheostomy tray will accompany the patient to the postanesthesia care unit and later to the patients room until breathing is unlabored and the chance of airway obstruction secondary to edema has passed.