Thyroidectomy is a surgery involving the removal of part or all of the thyroid gland. The delicate procedure is commonly performed to treat malignancy, benign disease or hormonal disease that is unresponsive to medications. These notes will outline the Thyroidectomy Pre-Operative Nursing Care, but before getting into that, make sure that you’ve read:
Thyroidectomy Pre-Operative Nursing Care Part 1: Assessment
The goal in the thyroidectomy pre-operative phase is to identify any risk factors that might complicate the surgery or the recovery and then implement strategies to reduce them. You need to perform five main tasks during the pre-operative nursing assessment. These include:
Obtaining the patient’s medical history
Performing a physical examination of the Thyroid Gland
Evaluating the patient’s psychosocial factors
Get all the required medical tests and imaging for Thyroidectomy
Ensure all pre-operative documentation is in order
If you need more details about the pre-operative nursing assessment, you can hop over to the previous notes.
Thyroidectomy Pre-Operative Nursing Care Part 2: Diagnoses
Incomplete Pre-Operative Documentation, Tests and Imaging
Deficient Knowledge
Anxiety and Fear
Dehydration
Thyroidectomy Pre-Operative Nursing Care Part 3: Interventions
1. Completing Pre-Operative Documentation, Medical Tests and Imaging
Like any other surgery, the patient needs to have several documents and tests completed before getting a Thyroidectomy. These will ensure that the patient is thoroughly screened for any potential complications that may arise intra-operatively.
Start by gathering all of the patient’s medical records and ensuring that the following are available:
Medical History
Physical Assessment
Informed Consent
Pre-Op Ward Checklist
Who Theatre Safety Checklist
Next up, you check whether the patient has taken the necessary blood tests for a thyroidectomy, including:
Serum Thyroid-Stimulating Hormone: To obtain a baseline of the thyroid function levels pre-operatively
Serum Free T4: measures the free unbound thyroxine (T4) which is the only part of T4 that is metabolically active.
Serum T3 and T4: measures the protein-bound and free hormone levels that occur in response to TSH secretion
T3 Resin Uptake: measures the amount of thyroid hormone bound to Thyroxine-Binding Globulin (TBG) and the number of available binding sites. If the thyroid is functioning at normal levels, around one-third of all TBGs should be complete, leaving the rest open to bind with the added T3 from the test.
Thyroid Antibodies: identifies thyroid antibodies that cause autoimmune thyroid disease.
Radioactive Iodine Uptake: measures the rate of iodine uptake by the thyroid gland. Patients with hyperthyroidism will have a high uptake of Iodine, whereas those with hypothyroidism will have a poor uptake.
Serum Thyroid Globulin: Detects the presence or recurrence of thyroid carcinoma
Following the blood tests, the patient might also need Medical Imaging before having a Thyroidectomy. These would include:
Fine-Needle Aspiration Biopsy: A small gauge needle is used to biopsy the thyroid tissue if a mass is detected on the thyroid. This will classify the group as benign, malignant, suspicious or insufficient.
Thyroid Ultrasound
Thyroid Scan: During a thyroid scan, the provider would use a scintillation detector or gamma camera to scan over the thyroid area and create an image of the distribution of radioactivity. The scan would determine the location, size, shape, and anatomic function of the thyroid gland
MRI or CT: Might be indicated if the patient has advanced disease, as they help determine the severity.
Chest X-Ray: To help determine whether the thyroid extends below the thoracic inlet.
2. Managing Knowledge Deficiency
Several studies have shown that patients who were well educated about their surgeries had better outcomes post-operatively. And this makes sense for a couple of reasons. Firstly being knowledgeable about the surgery will reduce the patient’s anxiety and fear of the unknown. So take time and use different resources without going into too much detail explaining the surgical pathway.
Start by explaining what a Thyroidectomy is, why it is needed and how it will help the patient in the future. Explain when they’ll be admitted, what things they should bring with them and whether there’s any change in their regular medication or new medication to be started before their admission. Go over the expected routine on the day of the surgery, how they will be prepared and if needed, when they have to start fasting. Discuss the type of anaesthesia and how long the surgery is expected to be.
It would help if you also talked about what they can expect in the post-operative phase. Indicate the site and size of the incision, and explain how it is managed post-operatively. More importantly, you should explain to your patient that following a Thyroidectomy, it is common for the surgeons to keep at least one or two drains close to the incision site. These drains will prevent blood pooling in the neck, which reduces swelling and prevents airway obstruction.
Discuss the necessary blood tests that will be taken to monitor the thyroid function post-operatively and the pain management plan to ease the patient’s anxiety. Lastly, you should also educate the patient about exercises that they’ll be required to perform post-operatively, including:
Deep breathing exercises to avoid post-op lung complications
Early ambulation reduces the risk of deep vein thrombosis, improves circulation, and avoids bed sores.
3. Managing Anxiety and Fear
Experiencing anxiety and fear before a Thyroidectomy is extremely common, and in most cases, this stress stems from a lack of understanding. Patients often feel anxious because they have no control over their situation, and similarly, they experience fear because they can not anticipate what is about to happen. However, these factors can be controlled through adequate education, support and anxiety controlling techniques.
Start by creating a safe space where your patient feels comfortable voicing their feelings and expressing their concerns. While talking to your patient, evaluate their body language. Constant fidgeting, avoidance, crying or not talking are all signs that the patient is uncomfortable. Ask the patient what they know about their situation and move on, educating as necessary. Moreover, assure the patient that the surgical team is professional and will do their utmost to ensure the best possible outcome.
Encourage your patient to join a support group or look out for other individuals who have previously had the same surgery. Sharing experiences can provide a greater sense of support and motivation for the patient. Lastly, you can use deep breathing techniques, music therapy or imagery to distract the patient and reorient their focus onto something more pleasant.
4. Managing Dehydration
Thyroidectomy requires general anaesthesia, which means that your patient will have to fast (not eat or drink) for 6 hours before the surgery. When giving anaesthesia and intubating, the patient is at risk of pulmonary aspiration, which increases drastically if the patient does not have an empty stomach. Despite the more recent studies showing that patients do not need to be starved for more than 6 hours and that clear fluid does not impact aspiration risk, most hospital protocols require patients to be starved from midnight. This extends the window of starvation, leaving the patient at risk of dehydration.
To counteract the extended period of starvation, most patients are started on IV fluids that keep their electrolytes balanced. In addition, if the patient has diabetes, their fluid regimen is slightly different. They will be on a diabetic protocol to control their blood glucose within a normal range.
NEXT UP: Thyroidectomy Post-Operative Nursing Care
References:
Biello A, Kinberg EC, Wirtz ED. Thyroidectomy. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563279/
Padur, A. A., Kumar, N., Guru, A., Badagabettu, S. N., Shanthakumar, S. R., Virupakshamurthy, M. B., & Patil, J. (2016). Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review. Journal of thyroid research, 2016, 7594615. https://doi.org/10.1155/2016/7594615
Gimm O, Brauckhoff M, Thanh PN, Sekulla C, Dralle H. An update on thyroid surgery. Eur J Nucl Med Mol Imaging. 2002 Aug;29 Suppl 2:S447-52. doi: 10.1007/s00259-002-0913-3. Epub 2002 Jul 11. PMID: 12192544.