{
  "name": "Thyroidectomy",
  "slug": "thyroidectomy",
  "url": "https://nursingplex.com/care-plans/thyroidectomy",
  "category": "Surgery & Perioperative",
  "summary": "Thyroid removal watch for airway swelling, hemorrhage, hypocalcemia and voice change.",
  "nursing_diagnoses": [
    "Ineffective airway clearance",
    "Risk for bleeding",
    "Impaired verbal communication"
  ],
  "overview": [
    "Thyroidectomy removes part or all of the thyroid gland for cancer, large goiter with compression, or hyperthyroidism unresponsive to medical therapy. Patients with hyperthyroidism are typically rendered euthyroid before surgery with antithyroid drugs and iodine to reduce vascularity and the risk of thyroid storm.",
    "The gland sits directly over the trachea and adjacent to the recurrent laryngeal nerves and parathyroid glands, so the classic complications are airway obstruction from bleeding or laryngeal edema, hoarseness or vocal cord paralysis, and hypocalcemia from parathyroid injury.",
    "Nursing care is airway-first: keeping suction, oxygen and a tracheostomy tray at the bedside, checking behind the neck for pooled blood, and monitoring calcium and voice quality closely for the first 48 hours."
  ],
  "key_facts": [
    {
      "label": "Bedside emergency kit",
      "text": "Keep suction, oxygen and a tracheostomy set immediately available for the first 24 hours."
    },
    {
      "label": "Hidden bleeding",
      "text": "Blood tracks behind the neck — slide a hand under the dressing to check posteriorly."
    },
    {
      "label": "Hypocalcemia signs",
      "text": "Circumoral tingling, numb fingertips, and positive Chvostek or Trousseau signs appear within 24–72 hours."
    },
    {
      "label": "Thyroid storm",
      "text": "High fever, tachycardia, agitation and hypertension after surgery is a life-threatening emergency."
    }
  ],
  "nursing_priorities": [
    "Maintain a patent airway and detect hematoma early.",
    "Monitor serum calcium and treat hypocalcemia.",
    "Assess voice quality for laryngeal nerve injury.",
    "Recognize thyroid storm.",
    "Support neck positioning, pain relief and hormone replacement teaching."
  ],
  "assessment": {
    "subjective": [
      "Reports of throat pain, difficulty swallowing or a sensation of tightness",
      "Complaints of tingling around the lips or in the fingers",
      "Reports of voice weakness or hoarseness",
      "Anxiety about breathing or the scar"
    ],
    "objective": [
      "Respiratory rate, stridor, use of accessory muscles, oxygen saturation",
      "Dressing and posterior neck for bleeding or swelling",
      "Serum calcium and ionized calcium levels; Chvostek and Trousseau signs",
      "Voice quality at regular intervals",
      "Temperature, heart rate and mental status for thyroid storm"
    ],
    "related_factors": [
      "Surgical manipulation near the trachea and laryngeal nerves",
      "Inadvertent parathyroid removal or devascularization",
      "Postoperative edema and hematoma formation",
      "Manipulation of a hyperactive thyroid gland releasing hormone"
    ]
  },
  "goals": [
    "The client will maintain a patent airway with unlabored breathing.",
    "The client will maintain serum calcium within normal limits.",
    "The client will demonstrate a normal or improving voice.",
    "The client will describe hormone replacement and follow-up requirements."
  ],
  "interventions": [
    {
      "title": "Airway protection",
      "points": [
        "Keep suction, oxygen and a tracheostomy tray at the bedside.",
        "Assess respiratory effort and for stridor frequently in the first 24 hours.",
        "Check the dressing and slide a hand behind the neck for pooled blood each assessment.",
        "Position semi-Fowler with the neck supported by pillows; teach hand support of the head when moving."
      ]
    },
    {
      "title": "Calcium and nerve monitoring",
      "points": [
        "Monitor calcium levels as ordered and assess for perioral or digital tingling.",
        "Test Chvostek and Trousseau signs and keep IV calcium gluconate available.",
        "Ask the patient to speak each hour initially; report progressive hoarseness or a weak breathy voice.",
        "Assess swallowing before giving oral fluids."
      ]
    },
    {
      "title": "Comfort and recovery",
      "points": [
        "Provide analgesia, humidified air and ice chips for throat discomfort.",
        "Limit talking early to rest the voice.",
        "Monitor for thyroid storm: fever, tachycardia, agitation — notify the provider immediately.",
        "Administer thyroid hormone replacement as prescribed after total thyroidectomy."
      ]
    }
  ],
  "patient_teaching": [
    "Explain lifelong thyroid hormone replacement and the need for periodic TSH checks after total removal.",
    "Teach how to support the head and neck when getting up.",
    "Report tingling, muscle cramps, difficulty breathing or worsening hoarseness.",
    "Review incision care and expected scar appearance."
  ]
}