Introduction

Thyroidectomy is the surgical removal of the thyroid gland, performed for colloid goiter,
tumors, or hyperthyroidism that does not respond to iodine therapy and anti-thyroid drugs.
Surgical removal of the thyroid is necessary in some situations where a goiter becomes life-
threatening or in the presence of some cancers.
Post-thyroidectomy treatment with thyroid hormone is routinely done to prevent a condition
known as myxedema. The lack of circulating thyroid hormone in the body gives rise to a
series of signs and symptoms which represent a severe form of hypothyroidism (underactivity
of the thyroid gland). There is swelling of the face and limbs because of fluid deposited under
the skin. This may particularly affect the area around the eyes, hands, and feet. The skin
becomes dry and rough and there may be some hair loss. The person exhibits slowness of
action and thought, and this mental dullness is accompanied by slow speech, with a voice
that may become hoarse. Lethargy and weakness may be associated with slowed reflexes, a
slow pulse, lowered metabolism and subnormal body temperature. Myxedema also may arise
through primary disease of the thyroid.
Surgical removal is the treatment of choice for most thyroid carcinomas. The appropriate
extent of removal is debatable; some surgeons favoring lobectomy and others near-total
thyroidectomy.
The patient is rendered hypothyroid by withdrawing thyroid hormone for four to six weeks until
the TSH (thyroid stimulating hormone) is significantly elevated to maximize the iodine uptake
by thyroid tissue. At this time, a tracer dose of radioiodine is given, uptake determination and
scan are done, and the ablative dose of 131I is calculated and given subsequently. This
allows visualization and therapy of the thyroid tissue left in place after surgery and even of
metastases that could not be visualized prior to thyroidectomy. Following this procedure, the
patient is placed on suppressive doses of T4 (thyroxine, a thyroid hormone) indefinitely.

The thyroid is a gland in the neck. It has two kinds of cells that make hormones. Follicular
cells make thyroid hormone, which affects heart rate, body temperature, and energy level. C
cells make calcitonin, a hormone that helps control the level of calcium in the blood.
The thyroid is shaped like a butterfly and lies at the front of the neck, beneath the voice box
(larynx). It has two parts, or lobes. The two lobes are separated by a thin section called the
isthmus.
A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin. A
swollen lobe might look or feel like a lump in the front of the neck. A swollen thyroid is called a
goiter. Most goiters are caused by not enough iodine in the diet. Iodine is a substance found
in shellfish and iodized salt.
Cancer is a group of many related diseases. All cancers begin in cells, the body's basic unit of
life. Cells make up tissues, and tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow
old and die, new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does not need
them, and old cells do not die when they should. These extra cells can form a mass of tissue
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called a growth or tumor. Growths on the thyroid are usually called nodules.
No one knows the exact causes of thyroid cancer. Doctors can seldom explain why one
person gets this disease and another does not. However, it is clear that thyroid cancer is not
contagious. No one can "catch" cancer from another person.
Research has shown that people with certain risk factors are more likely than others to
develop thyroid cancer. A risk factor is anything that increases a person's chance of
developing a disease.
All or part of the thyroid gland may be removed to correct a variety of abnormalities. If a
person has a goiter, which is an enlargement of the thyroid gland that causes swelling in the
front of the neck, the swollen gland may cause difficulties with swallowing or breathing.
Hyperthyroidism (overactivity of the thyroid gland) produces hypermetabolism, a condition in
which the body uses abnormal amounts of oxygen, nutrients, and other materials. A
thyroidectomy may be performed if the hypermetabolism cannot be adequately controlled by
medication, or if the condition occurs in a child or pregnant woman. Both cancerous and
noncancerous tumors (frequently called nodules) may develop in the thyroid gland. These
growths must be removed, in addition to some or all of the gland itself.
The mortality of thyroidectomy is essentially zero. Hypothyroidism is thought to occur in 12–
50% of persons in the first year after a thyroidectomy. Late-onset hypothyroidism develops
among an additional 1–3% of persons each year. Although hypothyroidism may recur many
years after a partial thyroidectomy, 43% of recurrences occur within five years.
Mortality from thyroid storm, an uncommon complication of thyroidectomy, is in the range of
20–30%. Thyroid storm is characterized by fever, weakness and wasting of the muscles,
enlargement of the liver, restlessness, mood swings, change in mental status, and in some
cases, coma. Thyroid storm is a medical emergency requiring immediate treatment . After a
partial thyroidectomy, thyroid function returns to normal in 90–98% of persons.

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 Definition of terms

Thyroidectomy - Thyroidectomy is the surgical removal of the thyroid gland

Radiation - describes any process in which energy travels through a medium or through
space, ultimately to be absorbed by another body.
Total Thyroidectomy -- Complete Removal of the Thyroid
Subtotal/Partial Thyroidectomy -- Removal of Half of the Thyroid Gland
Thyroid Lobectomy -- Removal of Only About a Quarter of the Gland
Hemithyroidectomy - Removing one lobe of the thyroid and the isthmus.
Isthmusectomy - Removal of the section of thyroid that joins the two lobes (uncommonly
used)
Physical exam—The doctor will feel the neck, thyroid, voice box, and lymph nodes in the neck
for unusual growths (nodules) or swelling.
Blood tests—The doctor may test for abnormal levels (too low or too high) of thyroid-
stimulating hormone (TSH) in the blood. TSH is made by the pituitary gland in the brain. It
stimulates the release of thyroid hormone. TSH also controls how fast thyroid follicular cells
grow.

Ultrasonography—The ultrasound device uses sound waves that people cannot hear. The
waves bounce off the thyroid, and a computer uses the echoes to create a picture called a
sonogram. From the picture, the doctor can see how many nodules are present, how big they
are, and whether they are solid or filled with fluid.
Radionuclide scanning—The doctor may order a nuclear medicine scan that uses a very
small amount of radioactive material to make thyroid nodules show up on a picture. Nodules
that absorb less radioactive material than the surrounding thyroid tissue are called cold
nodules. Cold nodules may be benign or malignant. Hot nodules take up more radioactive
material than surrounding thyroid tissue and are usually benign.
Biopsy—the removal of tissue to look for cancer cells is called a biopsy. A biopsy can show
cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only
sure way to know whether a nodule is cancerous.

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 Discussion of Surgical Procedures

Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The
thyroid gland is located in the forward part of the neck (anterior) just under the skin and in
front of the Adam's apple. A thyroidectomy may be performed by using a conventional
surgical approach or a newer endoscopic method. Conventional thyroidectomy is performed
for the following reasons:
• To remove malignant (cancerous) or benign (noncancerous) thyroid tumors
• To treat thyrotoxicosis, a condition in which an overactive thyroid gland produces
extremely high levels of thyroid hormone
• To remove all or part of a goiter (an enlarged thyroid gland) that is pressing on
neighboring structures in the neck, especially if this pressure interferes with swallowing
or breathing
• To remove and evaluate an undiagnosed thyroid mass
In some people, as an alternative to a conventional thyroidectomy, an endoscopic
thyroidectomy can be performed to remove small thyroid cysts or small benign thyroid
nodules (less than four centimeters, or about one and a half inches). Endoscopic
thyroidectomy is not used to treat multiple thyroid nodules, thyroid cancer or thyrotoxicosis.
Thyroid disorders do not always develop rapidly; in some cases, the patient's symptoms may
be subtle or difficult to distinguish from the symptoms of other disorders. Patients suffering
from hypothyroidism are sometimes misdiagnosed as having a psychiatric depression. Before
a thyroidectomy is performed, a variety of tests and studies are usually required to determine
the nature of the thyroid disease. Laboratory analysis of blood determines the levels of active
thyroid hormones circulating in the body. The most common test is a blood test that measures
the level of thyroid-stimulating hormone (TSH) in the bloodstream. Sonograms and computed
tomography scans (CT scans) help to determine the size of the thyroid gland and location of
abnormalities. A nuclear medicine scan may be used to assess thyroid function or to evaluate
the condition of a thyroid nodule, but it is not considered a routine test. A needle biopsy of an
abnormality or aspiration (removal by suction) of fluid from the thyroid gland may also be
performed to help determine the diagnosis.
If the diagnosis is hyperthyroidism, a person may be asked to take antithyroid medication or
iodides before the operation. Continued treatment with antithyroid drugs may be the treatment
of choice. Otherwise, no other special procedure must be followed prior to the operation.
There are definite risks associated with the procedure. The thyroid gland should be removed
only if there is a pressing reason or medical condition that requires it.
As with all operations, people who are obese, smoke, or have poor nutrition are at greater risk
for developing complications related to the general anesthetic itself.
Hoarseness or voice loss may develop if the recurrent laryngeal nerve is injured or destroyed
during the operation. Nerve damage is more apt to occur in people who have large goiters or
cancerous tumors.
Hypoparathyroidism (underfunctioning of the parathyroid glands) can occur if the parathyroid
glands are injured or removed at the time of the thyroidectomy. Hypoparathyroidism is
characterized by a drop in blood calcium levels resulting in muscle cramps and twitching.

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Hypothyroidism (underfunctioning of the thyroid gland) can occur if all or nearly all of the
thyroid gland is removed. Complete removal, however, may be intentional when the patient is
diagnosed with cancer. If a person's thyroid levels remain low, thyroid replacement
medications may be required for the rest of his or her life.
A hematoma is a collection of blood in an organ or tissue, caused by a break in the wall of a
blood vessel. The neck and the area surrounding the thyroid gland have a rich supply of blood
vessels. Bleeding in the area of the operation may occur and be difficult to control or stop. If a
hematoma occurs in this part of the body, it may be life-threatening. As the hematoma
enlarges, it may obstruct the airway and cause a person to stop breathing. If a hematoma
does develop in the neck, the surgeon may need to perform drainage to clear the airway.
Wound infections can occur. If they do, the incision is drained, and there are usually no
serious consequences.

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 Anatomy and Physiology

Location. The thyroid gland lies in the anterior neck, below the larynx (see Figure
1). It is a highly vascular organ, and consists of two lobes that are connected by an
isthmus, which is usually positioned at the level of the upper three tracheal rings.
The superior pole of each lobe of the thyroid gland covers the lateral aspects of the
thyroid cartilage. The thyroid gland is attached to the trachea by a dense
connective tissue inferior to the cricoid cartilage.

FIGURE 1: Illustration of the thyroid and parathyroid glands and their relationship to the
larynx and trachea. From Anatomy and Physiology (3rd ed.) (p.558), by G.A. Thibodeau and
K.T. Patton, 1996, St. Louis: Mosby-Year Book, Inc. Copyright 1996 from Mosby-Year Book,
Inc.

Blood and Lymphatic Supply. Blood is supplied to the thyroid gland from paired
superior thyroid arteries that arise from the external carotids, and two inferior
thyroid arteries that stem from the thyrocervical trunk. Most individuals possess a
fifth vessel called the thyroid ima, which originates from the aortic arch and enters
the isthmus inferiorly (Litwack-Saleh, 1992). The thyroid gland is drained by three
pairs of vessels: the superior, middle and inferior thyroid veins. These veins extend
from a plexus formed on the surface of the gland. The lymphatic drainage of the
thyroid gland is by way of the isthmus and Delphian (prelaryngeal) node medially
and the paratracheal and deep cervical nodes laterally.

Nerve Supply. The thyroid gland receives its innervation primarily by the superior
laryngeal nerves (SLN) and the recurrent laryngeal nerves (RLN). The posterior
6
lateral portions of each lobe of the thyroid gland lie in extreme close proximity to
each RLN. The SLNs lie in close proximity to the superior thyroid artery and
bifurcate into the internal and external branches. The internal branch of the SLN is
sensory and supplies sensation to the larynx above the level of the vocal cords.
The SLN also has branches to the base of the tongue. The external branch of the
SLN innervates the cricothyroid muscles, which tense the vocal cords.
The path of the RLN follows a different course on each side of the body (Linder,
1989). On the right, the RLN exits the right vagus nerve and loops under the right
subclavian vein, travels through the tracheoesophageal groove, and pierces the
cricothyroid membrane posteriorly. Conversely, the left RLN is a branch of the left
vagus nerve; it loops around the aorta and courses along the tracheoesophageal
groove, entering the larynx through the posterior cricothyroid membrane. Because
of its longer course, the left RLN is more vulnerable to disease and traumatic injury
than the right RLN. The RLNs supply motor innervation to the intrinsic laryngeal
muscles. These muscles assist in changing the position of the cricoid, arytenoid,
and thyroid cartilages, thus affecting both the tension and length of the vocal cords.
The RLN also supplies sensory innervation to the larynx below the level of the
vocal cords.

Secretory Function. The primary function of the thyroid gland is to secrete two
hormones, thyroxine (T4) and triiodothyronine (T3) (Johnson, 1995). Figure 2
illustrates the secretory function of the thyroid and associated organs. These
thyroid hormones serve several purposes that include (a) regulating carbohydrate
and lipid metabolism, (b) stimulating oxygen consumption by cells, and (c)
controlling growth and development. The production and secretion of thyroid
hormones by the thyroid gland are controlled by the thyroid stimulating hormone
(TSH) produced by the pituitary gland. TSH is, in turn, regulated by the thyroid-
releasing hormone (TRH) secreted from the hypothalamus. Iodine is necessary to
synthesize thyroid hormones. Ingested iodine is absorbed into the circulatory
system and stored in the thyroid before being converted into thyroid hormones.

Parathyroid Glands. The parathyroid glands are small pieces of reddish-brown

tissue that lie on both sides of the thyroid gland. While most individuals possess
four parathyroid glands, two superior and two inferior, total numbers of parathyroid
glands vary among individuals. These glands are responsible for producing
parathyroid hormone, which, along with vitamin D, regulate calcium and
phosphorus concentrations in the body. Compromise of the vascular system to the
parathyroids during thyroid surgery may result in ischemia and subsequent
transient hypocalcemia. Since the inadvertent removal of the parathyroid glands
may result in severe tetany and death, care must be taken by the surgeon to
identify and preserve the parathyroid glands during surgery.

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 Pathophysiology

The pathophysiology of thyroid cancer is not completely defined. Alterations of

several molecular factors have been associated with thyroid malignancy. These
include proliferative factors such as growth hormones and oncogenes, and
apoptotic and cell-cycle inhibitory factors such as tumour suppressors.
Physiological behaviour depends upon tumour type. Thyroid cancer is thought to
reflect a continuum from well-differentiated to anaplastic, characterised by early
and late genetic events. Up to one third of patients with differentiated thyroid
cancer experience tumour de-differentiation, accompanied by increased tumour
grade and loss of thyroid-specific functions such as iodine accumulation.
Papillary carcinoma tends to spread to local lymph nodes, whereas follicular and
Hurthle cells more often spread haematogenously. Anaplastic thyroid cancer is a
rare, aggressive, undifferentiated carcinoma with a high propensity for local
invasion and metastatic spread. Nodal spread is common with thyroid
lymphomas.

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 Instrumentation

Sharps

1.) 2.) 3.)

Forceps / Clamps

4.) 5.) 6.)

7.) 8.)

9
9.) 10.) 11.)

Retractors

12.)

10
1) Needle Holders To hold and guide suture needles securely for
suturing
2) Mayo Scissors -To cut and dissect tissue; To cut sutures, clothing,
bandages
3) Metzenbaum Scissors - To dissect tissue.
4) Scalpel Handle - To hold scalpel blades.
5) Mosquito Forceps - To clamp and restrict arteries or tissue, to
control the flow of Blood.
6) Towel Forceps - To attach towels, to handle sponges and other
material
7) Curved/ Straight Kelly forceps - a curved hemostat without teeth,
used primarily for grasping vascular tissue in gynecologic
procedures
8) Dressing/Thumb Forceps - To grasp and handle dressing and other
material
9) Tissue Forceps To grasp and handle soft tissue
10)Army Navy Retractor - Hand held retractor used for deep or shallow
retraction of large muscle retraction during orthopedic or
neurological procedures.
11)Richardson - A surgical instrument used to hold back organs or the
edges of an incision.

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 Procedural steps

A thyroid surgery begins with 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.

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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.

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 NURSING RESPONSIBILITIES

Preoperative Nursing Care

A thorough understanding of the potential complications following thyroid surgery
can provide the nurse with a focus during the initial nursing assessment as well
as the postoperative period. It is vital that patient teaching begin prior to hospital
admission, following the initial diagnosis by the physician. The preoperative
assessment should include an anesthesia consult as well as the evaluation of all
diagnostic tests conducted on the patient. During this time the surgeon should
review the risks of thyroid surgery with the patient; informed consent must be
obtained.
The nurse should conduct a thorough nursing assessment on the patient. This
assessment consists of detailed data describing both physical and psychosocial
aspects of the patient. Essential information should include the patient's cardiac
and respiratory status, muscle strength, emotional state, elimination pattern, skin
condition, weight history, and voice quality.
Often, patients diagnosed with hyperthyroid conditions have been evaluated and
treated medically with successful control of thyroid hormone levels and their
metabolic state. Characteristics of a hypermetabolic state may include such
symptoms as the following: increased pulse and blood pressure, palpitations,
weakness, nervousness and agitation, frequent watery stools, find moist skin,
and weight loss.
Patients diagnosed with thyroid disease may experience anxiety preoperatively
related to their anticipation of the surgical procedure. Some patients may express
concern about the cosmetic impact of the surgery. Whatever the concern, the
nurse should discuss these feelings with the patient preoperatively and provide
appropriate interventions to help reduce stress.
Preoperatively, the nurse should carefully assess the condition of the patient's
skin, as well as the voice quality. Patients diagnosed with a hyperthyroid state
may have thin, textured skin and edema of the lower extremities. Such problems
may place these patients at risk for injury intraoperatively and for problems with
wound healing and infection postoperatively. In addition, preoperative
assessment of voice quality is essential postoperatively in detecting early
evidence of nerve injury, such as hoarseness.
Various degrees of airway obstruction and dysphagia may be present
preoperatively in patients diagnosed with thyroid problems. An enlarged thyroid
gland may compress the structures in the neck and interfere with their function.
Preoperatively, the nurse should document any enlargement noted in the
patient's neck, and/or complaints made by the patient concerning difficulty
swallowing or breathing. The anesthesia care provider will need to evaluate the
patient's airway for expected difficulties with intubation that may be the result of
tracheal compression or deviation. Assessment for evidence of cervical spine

14
injury or disease is also necessary to prevent complications related to positioning
in the operating room. Hyperextension of the neck using a shoulder roll and head
rest allows the surgeon optimal visualization of the surgical field. This is generally
the standard position for thyroid surgery, but may present a risk for injury to the
cervical spine if precautions are not taken.
Finally, diagnostic test results should be reviewed and included in the
preoperative assessment. Possible laboratory tests include a complete blood
count, thyroid hormone levels, and serum calcium and phophorus
concentrations. The results of other tests, such as imaging studies and a fine
needle aspiration (FNA) biopsy, often performed on patients with thyroid nodules,
allow the nurse to evaluate the thyroid diagnosis preoperatively and to anticipate
potential problems that may occur postoperatively.

Postoperative Nursing Care

The postoperative phase begins when the patient arrives in the postanesthesia
care unit. The nurse must be alert to postanesthetic priorities, carefully
monitoring the patient's cardiopulmonary status, neurological status, comfort
level, surgical wound condition, and metabolic state. The nurse should monitor
the patient's level of consciousness, vital signs, EKG, and pulse oximetry. The
nurse should assess the patient's pain level and provide individualized
management as ordered.
Airway obstruction in the thyroidectomy patient immediately following surgery
may be the result of several conditions. These include laryngospasm, laryngeal
edema due to surgical manipulation, laryngeal obstruction due to bilateral vocal
cord paralysis, or tracheal compression from hematoma formation. The nurse
should continually assess and document the patient's airway patency, oxygen
saturation levels, and respiratory status. Bleeding should be carefully noted, both
on the patient's dressing and from the surgical drains. The nurse should
document the presence of drains, the amount and consistency of drainage, and
the functioning status of the equipment. The nurse should monitor the patient's
dressing for changes in drainage and tightness. The nurse should also note the
presence of neck swelling (edema) around the edge of the neck dressing. A
progressively enlarging mass noted in the neck of a thyroidectomy patient
without a dressing may suggest the formation of a hematoma. The presence of
hypotension and tachycardia may also signify bleeding. The availability of and
quick access to a tracheostomy tray are vital.
The nurse should also observe the thyroidectomy patient for evidence of
metabolic disturbances, such as thyroid storm and hypocalcemia. Thyroid storm,
described above, usually occurs intraoperatively or up to 18 hours
postoperatively (Litwack-Saleh, 1992). Treatment is directed toward identification
and control of symptoms.
Hypocalcemia symptoms are usually manifested 24 to 72 hours after thyroid
surgery (Litwack-Saleh, 1992). The nurse should assess the patient for any
numbness or tingling around the lips or hands. Neuromuscular irritability,

15
indicating hypocalcemia and potential tetany, may be demonstrated in the patient
by two tests, the Trousseau and Chvostek. A positive Trousseau's sign is carpal
spasm induced by arterial occlusion of the arm with a blood pressure cuff (Figure
3), and a positive Chvostek's sign is facial nerve irritability/spasms elicited by
tapping the nerve (Figure 4). Since severe hypocalcemia can lead to laryngeal
stridor and convulsions, the nurse should immediately report any symptoms to
the physician. Serum calcium level measurements are usually ordered daily,
especially if the patient is symptomatic. Tetany is usually relieved with calcium
replacements, such as 10% calcium gluconate solution administered
intravenously.
Because of the potential for laryngeal nerve damage intraoperatively, the nurse
should evaluate the patient's voice quality and swallowing postoperatively. Any
change in voice or problems with aspiration should be reported to the physician
and documented. If needed, flexible laryngoscopy at the bedside or in the office
can assist the physician in determining vocal cord function and possible
treatment.

Discharge Teaching
Discharge teaching for the patient following a thyroidectomy should include
information regarding the signs and symptoms of potential complications as
previously described. It is also important to include information about how and
when to contact the physician, plus written and verbal information regarding
medications, wound care, nutrition, and follow-up visits with the physician. The
nurse must be sure that the patient demonstrates an understanding of all aspects
of home care. The family and significant others should be included in discharge
teaching.

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