Care of the thyroid and parathyroid surgical patient

39 Care of the thyroid and parathyroid surgical patient

Surgery of the thyroid gland was first performed around ad 500, and the first successful removal of a goiter occurred in ad 1000. By the 1800s, numerous thyroidectomies had been performed; however, nearly half of the patients died after surgery as a result of tetany. This morbidity rate was secondary to the removal of the parathyroid glands, whose function was not well understood at the time. In the early 1900s, a greater understanding of the role of the parathyroid glands promoted the subtotal thyroidectomy procedure which significantly reduced postoperative complications. In the late 1990s, endoscopic and minimally invasive techniques further reduced some postoperative complications and expanded the number of outpatient cases performed. The type of thyroid surgical procedure chosen depends on the patient’s age, tumor cell type and size, presence of an encapsulated or extracapsular tumor, and any invasion of adjacent structures (Fig. 39-1).


FIG. 39-1 Thyroid gland and surrounding anatomic structures.

(From Elisha S, et al: Anesthesia case management for thyroidectomy, AANA J 78(2):152, 2010.)


Surgery on the thyroid and parathyroid glands is commonly performed with general anesthesia. Regional and local techniques, such as a cervical plexus blockade, are growing in popularity as minimally invasive techniques and the number of outpatient cases grows.13 Appropriate postoperative care for a patient receiving general anesthesia is instituted in the postanesthesia care unit. Minimally invasive techniques and those procedures performed with regional or local anesthesia may minimize the recovery requirements for this patient population.

Perianesthesia nursing care

Dressings and drains

Postoperative dressings are small, and drains are generally not required. Postoperative drainage is minimal and should not visibly soak through the dressing. Some disagreement persists regarding the use of surgical drains. There are questions regarding whether the presence of a drain causes increased pain, scarring, cost, length of stay, and a drain’s limited ability to identify and prevent hematoma.4,5 Drains may be indicated in the presence of greater intraoperative blood loss or an extensive procedure or when a large space is left after removal of a tumor or goiter.

Evidence-Based Practice

Debate about drain placement and the associated effects on scarring, infection, hematoma, and length of stay continues for the postthyroidectomy patient population. In a randomized prospective clinical trial, 55 patients requiring thyroidectomy were randomly assigned to drain and no-drain groups. The researchers found statistically significant results demonstrating that the no-drain group had a 1.12-day reduction in hospital stay, a cost savings of $2177 per patient, and no increase in postoperative complications.

Nov 6, 2016 | Posted by in NURSING | Comments Off on Care of the thyroid and parathyroid surgical patient

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