Thyroidectomy

A thyroidectomy removes part or all of the thyroid gland, most often for cancer, compressive goitre, hyperthyroidism, or suspicious thyroid nodules. The surgical incision may be small, but the operative field sits beside the trachea, recurrent laryngeal nerves, and parathyroid glands. These structures determine the priorities after surgery. A neck hematoma can compress the trachea within minutes. Recurrent laryngeal nerve injury can alter the voice or, if bilateral, compromise the airway. Parathyroid injury, removal, or impaired blood supply can lower parathyroid hormone (PTH), reducing the body’s ability to maintain serum calcium. Hypocalcemia may not be obvious immediately after surgery, so a patient who initially appears well can deteriorate later in the shift. After a total thyroidectomy, lifelong thyroid hormone replacement is usually required because no thyroid tissue remains to produce hormone. After a hemithyroidectomy, thyroid hormone replacement depends on postoperative thyroid function testing and the prescriber’s plan.