THYROIDECTOMY

 

A thyroidectomy is a surgical procedure that involves the removal of all or part of the thyroid gland. The thyroid gland is located in the neck and produces hormones that regulate the body's metabolism. Thyroidectomy is commonly performed for several reasons, including:

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1. Thyroid Cancer: To remove cancerous thyroid tissue.

2. Goiter: To remove a large thyroid gland that may be causing discomfort or breathing difficulties.

3. Hyperthyroidism: To treat an overactive thyroid gland when other treatments are not suitable.

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The procedure can be either a total thyroidectomy (removal of the entire gland) or partial (removal of part of the gland). The approach and extent of surgery depend on the reason for the surgery and the condition of the patient

                                                                                                 

                                                        Anesthetic Implications for Thyroidectomy

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Anesthesia type: General, local anesthesia

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Airway: ETT, Neuromonitoring ETT, LMA

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Preoperative:

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• Ideally, patients are clinically and chemically euthyroid prior to surgery

• Assess for airway compromise

• Assess goiter or nodule for size and extent of the lesion

• Large goiter can compress the airway or cause vocal cord paralysis

• Awake fibreoptic intubation may be used

• Be careful with preoperative sedation

• A Chest X-ray may be useful to assess the size of goitre and detect any tracheal compression or deviation

• Assess for signs of hyperthyroidism or hypothyroidism

• Check with the surgeon regarding muscle paralytics and nerve monitoring

• A NIM (Nerve Integrity Monitor) EMG endotracheal tube may be used (monitors manipulation of the recurrent laryngeal nerve)

• Muscle relaxants are not used if nerve monitoring is performed

• Hyperthyroid patients are frequently hypovolemic

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Intraoperative:

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• The thyroid gland is very vascular,

• May have to avoid paralytic due to recurrent laryngeal nerve monitoring

• Steroids (e.g. dexamethasone 8mg) may help to reduce airway edema

• Position: Supine, arms tucked, shoulder roll

• Duration: 1-2 hours

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Postoperative:

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• Deep smooth extubation

• Avoid bucking/coughing

• Minimize airway manipulation

• High risk of PONV

• Postoperative calcium levels 

• Hypocalcemia signs include stridor and laryngospasm

• Bilateral injury to the recurrent laryngeal nerves (RLN) can cause vocal cord paresis and stridor

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Complications:

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• Hypocalcemia

• Bleeding

• Pneumothorax

• Laryngeal edema

• Recurrent laryngeal nerve injury

• Superior laryngeal nerve injury

• Phrenic nerve injury

• Parathyroid glands injury

• Neck hematoma

• Airway compromise

• Thyroid storm

• Tracheomalacia

• Vascular injury

• Thoracic duct injury 

• Tracheal injury

• Esophageal injury

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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