I. Indications: thyroid cancer, hyperthyroidism, large goiters
constricting tissues or structures in the neck
a. May be done as an open, minimally invasive, or endoscopic
b. Video-assisted, minimally invasive surgical technique that
markedly shortens incision length to typically around 1 in.
versus 3 in. with traditional surgical procedure
c. Totally endoscopic procedure that involves the creation of
an invisible incision—using special instrumentation and
technique—with part or all of the thyroid gland removed
through small puncture sites in the underarm area and
avoiding a neck incision.
d. Total thyroidectomy: Entire gland and surrounding lymph
nodes are removed.
i. Performed in cases of malignancy or when there is a
high risk of developing multiple sites of thyroid cancer
ii. Presence of numerous separate nodules
iii. Enlarged thyroid makes breathing and swallowing
e. Lobectomy: Lobe is removed with or without the isthmus
between the lobes.
i. Done to remove single nodule or multiple nodules in a
f. Subtotal thyroidectomy: Up to five-sixths of the gland is
i. Performed when antithyroid drugs do not correct
hyperthyroidism or RAI therapy is contraindicated
ii. Procedure of choice for hyperthyroidism, with 95% cure
III. Statistics (Fallon, 2003)
a. Frequency of procedure: In 2001, approximately
34,500 cases performed in United States.
b. Morbidity: 12% to 50% of individuals develop hypothyroidism
within first year.
c. Mortality: Essentially zero for procedure, or about the level
associated with general surgery (Kaplan & Angelos, 2006);
in thyroid storm (rare complication) 20% to 30%.
Care is given in an inpatient acute surgical unit.
Hyperthyroidism (Graves’ disease, thyrotoxicosis),
Psychosocial aspects of care,
1. Reverse and manage hyperthyroid state preoperatively.
2. Prevent complications.
3. Relieve pain.
4. Provide information about surgical procedure, prognosis,
and treatment needs.
1. Complications prevented and minimized.
2. Pain alleviated.
3. Surgical procedure and prognosis and therapeutic regimen
4. Plan in place to meet needs after discharge.