What Is The Thyroidectomy Side Effects ....
Thyroidectomy is performed for a variety of thyroid conditions. A solitary nodule is removed because it may be a neoplasm and because it may press oil the trachea and cause obstruction to breathing. A generalized enlarge¬ment may be operated on because it too may cause tracheal obstruction, and to prevent gross deformity. Thyrotoxicosis is an indication for surgery to reduce the mass of the gland and hence limit its hypersecretion of the thyroid hormones that control the metabolic rate: other lines of treatment for thyrotoxicosis are the anti-thyroid drugs and radioactive iodine.
Preparation for operation
The recurrent laryngeal nerves lie close behind the thyroid gland, one on either side of the trachea, and control the movements of the vocal cords. They are at some risk during operations on the thyroid. The cutting of one nerve produces a varying degree of hoarseness, but this symptom usually improves with time as the opposite vocal cord increases its activity in compensation. Injury to both nerves is a catastrophe because the para¬lysed vocal cords fall together and obstruct the movement of air in and out of the chest: a permanent tracheostomy must be constructed and normal speech is impossible.
Because or the serious effect of damage to these nerves, and because it is not very IIIIC01111/1011 lo find patients who already have a weakness of a vocal cord before II iyroidectomy, many surgeons insist that the patient is examine(' by an car, nose and throat surgeon before operation, and the state of his vocal cords assessed as a baseline for comparison with the situation alter operation.
Control of thyrotoxlcosis
To perform I hyroidectomy on a patient with thyrotoxicosis is dangerous: the manipulation of the gland during the operation liberates large qUall¬tities of thyroxine into the bloodstream and produces an intensification of
'hyrotoxicosis, thyroid crisis, that can prove fatal. The thyrotoxicosis must therefore be brought under control by medical measures before the opera-tion. Potassium Iodide, 60 mg t.d.s. for 10 to 14 days before operation, may be used for this purpose.
This regime is often used even if the patient has been made euthyroid (normal in thyroid function) by the slow-acting drugs such as Neo¬Mercazole during the preceding months, because many claim that the iodine treatment reduces the vascularity of the gland and makes the opera¬tion easier. The nurse may be able to record objective evidence that the anti- thyroid treatment is working; a falling pulse rate (especially the sleeping pulse rate) and a rise in weight.
The wound
Reactionary haemorrhage is a dreaded complication during the first 24 to 48 hours. The tissues of the neck are particularly vascular, and to make the operation easier the anaesthetist often lowers the blood pressure. If the blood pressure does not regain its normal level before the surgeon closes the wound the subsequent rise in blood pressure to normal levels may result in a haematoma if haemostasis was not perfect. The seriousness of this complication is that a large collection of blood in the neck compresses the trachea and produces acute obstruction to respiration. The nurse may find the patient suddenly changes from his normal appearance to a choking, blue figure gasping for breath, with an obvious swelling in the neck. This is an emergency of the greatest magnitude, and while aid should be summoned immediately the nurse should not hesitate to act if no doctor or senior nurse Is present.
The life-saving procedure is to open up the skin wound so that the blood can reach the exterior instead of building up pressure in the neck. Sterile stitch-scissors or Michel clip-removers should be kept at the bedside for 24 hours after operation. The gush of blood from the opened wound may be an alarming sight, but the nurse may take comfort that the rate of bleeding will never be so fast as to kill the patient by loss of blood in less than an hour, whereas the same blood loss into the neck can by obstructing the trachea produce death in four minutes. Once the pressure has been relieved, arrangements can be made to return the patient to the operating theatre where the surgeon will re-explore the wound and stop the bleeding.
Wound drains. Most surgeons use drains in an effort to avoid the above complication. These can usually be removed by the second or third day. Skin closure is by sutures or metal clips. In either case, since the wound heals very rapidly, they may be removed on the third or fourth day.
Thyrotoxic crisis. Danger signals are a rise in pulse rate, blood pressure and temperature, agitation progressing through confusion to stupor, and sweating. This complication is very rare nowadays. Treatment includes sedation and intravenous iodine and attempts to lower the temperature, e.g. ice-packs. The drug propranolol is useful in combating the toxic effects of thyroxine upon the heart.
Recurrent laryngeal nerve. The patient is often hoarse for a few days, but this does not necessarily mean that a recurrent laryngeal nerve has been damaged; the hoarseness may result from the irritation of the endo¬tracheal tube used by the anaesthetist. The ear, nose and throat surgeon examines the cords again before the patient leaves hospital. The nurse should not discuss the prognosis of hoarseness or the likely outcome of
damage to the nerve: all queries from the patient should be referred to the medical staff or a senior nurse.
Thyroidectomy is performed for a variety of thyroid conditions. A solitary nodule is removed because it may be a neoplasm and because it may press oil the trachea and cause obstruction to breathing. A generalized enlarge¬ment may be operated on because it too may cause tracheal obstruction, and to prevent gross deformity. Thyrotoxicosis is an indication for surgery to reduce the mass of the gland and hence limit its hypersecretion of the thyroid hormones that control the metabolic rate: other lines of treatment for thyrotoxicosis are the anti-thyroid drugs and radioactive iodine.
Preparation for operation
The recurrent laryngeal nerves lie close behind the thyroid gland, one on either side of the trachea, and control the movements of the vocal cords. They are at some risk during operations on the thyroid. The cutting of one nerve produces a varying degree of hoarseness, but this symptom usually improves with time as the opposite vocal cord increases its activity in compensation. Injury to both nerves is a catastrophe because the para¬lysed vocal cords fall together and obstruct the movement of air in and out of the chest: a permanent tracheostomy must be constructed and normal speech is impossible.
Because or the serious effect of damage to these nerves, and because it is not very IIIIC01111/1011 lo find patients who already have a weakness of a vocal cord before II iyroidectomy, many surgeons insist that the patient is examine(' by an car, nose and throat surgeon before operation, and the state of his vocal cords assessed as a baseline for comparison with the situation alter operation.
Control of thyrotoxlcosis
To perform I hyroidectomy on a patient with thyrotoxicosis is dangerous: the manipulation of the gland during the operation liberates large qUall¬tities of thyroxine into the bloodstream and produces an intensification of
'hyrotoxicosis, thyroid crisis, that can prove fatal. The thyrotoxicosis must therefore be brought under control by medical measures before the opera-tion. Potassium Iodide, 60 mg t.d.s. for 10 to 14 days before operation, may be used for this purpose.
This regime is often used even if the patient has been made euthyroid (normal in thyroid function) by the slow-acting drugs such as Neo¬Mercazole during the preceding months, because many claim that the iodine treatment reduces the vascularity of the gland and makes the opera¬tion easier. The nurse may be able to record objective evidence that the anti- thyroid treatment is working; a falling pulse rate (especially the sleeping pulse rate) and a rise in weight.
The wound
Reactionary haemorrhage is a dreaded complication during the first 24 to 48 hours. The tissues of the neck are particularly vascular, and to make the operation easier the anaesthetist often lowers the blood pressure. If the blood pressure does not regain its normal level before the surgeon closes the wound the subsequent rise in blood pressure to normal levels may result in a haematoma if haemostasis was not perfect. The seriousness of this complication is that a large collection of blood in the neck compresses the trachea and produces acute obstruction to respiration. The nurse may find the patient suddenly changes from his normal appearance to a choking, blue figure gasping for breath, with an obvious swelling in the neck. This is an emergency of the greatest magnitude, and while aid should be summoned immediately the nurse should not hesitate to act if no doctor or senior nurse Is present.
The life-saving procedure is to open up the skin wound so that the blood can reach the exterior instead of building up pressure in the neck. Sterile stitch-scissors or Michel clip-removers should be kept at the bedside for 24 hours after operation. The gush of blood from the opened wound may be an alarming sight, but the nurse may take comfort that the rate of bleeding will never be so fast as to kill the patient by loss of blood in less than an hour, whereas the same blood loss into the neck can by obstructing the trachea produce death in four minutes. Once the pressure has been relieved, arrangements can be made to return the patient to the operating theatre where the surgeon will re-explore the wound and stop the bleeding.
Wound drains. Most surgeons use drains in an effort to avoid the above complication. These can usually be removed by the second or third day. Skin closure is by sutures or metal clips. In either case, since the wound heals very rapidly, they may be removed on the third or fourth day.
Thyrotoxic crisis. Danger signals are a rise in pulse rate, blood pressure and temperature, agitation progressing through confusion to stupor, and sweating. This complication is very rare nowadays. Treatment includes sedation and intravenous iodine and attempts to lower the temperature, e.g. ice-packs. The drug propranolol is useful in combating the toxic effects of thyroxine upon the heart.
Recurrent laryngeal nerve. The patient is often hoarse for a few days, but this does not necessarily mean that a recurrent laryngeal nerve has been damaged; the hoarseness may result from the irritation of the endo¬tracheal tube used by the anaesthetist. The ear, nose and throat surgeon examines the cords again before the patient leaves hospital. The nurse should not discuss the prognosis of hoarseness or the likely outcome of
damage to the nerve: all queries from the patient should be referred to the medical staff or a senior nurse.
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