Thyroidectomy-PatientInformation

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Thyroidectomy-Patient Information

Author's note

This information describes what a patient may expect when having the described operation. The information is specific to the author's practice. Other surgeons will doubtless differ in their preferences. The script can be down loaded and edited to suit other surgeons. You will need Abobe Acrobat Reader which can be downloaded from http://www.adobe.com/uk/products/acrobat/readermain.html


Click here for the PDF version of the script


Michael Edwards

Email [email protected]


Thyroidectomy

Your Thyroid Operation - Some Information

These notes give a guide to your stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.


What is a thyroid?

The thyroid (thigh-roid) is an H-shaped gland. It lies just in front of the windpipe in the neck. It is about 3 inches across.

It makes the hormone thyroxine (thigh-rox-in). Thyroxine passes into the blood stream to keep the body active. If the gland makes too much thyroxine, the body gets overactive and the heart can be strained.

If the gland swells, it presses on the windpipe and other parts of the neck. It may cause an ugly swelling in the front of your neck. Sometimes a tumour causes the swelling. Then the gland, or parts of it, need to be removed.


What does the operation consist of?

A cut is made across the front of your neck. Some or all of the thyroid is taken out. We aim to leave you enough thyroid to supply your needs of thyroxine. Sometimes this is not possible, and we can easily give you tablets of thyroxine to top up your supplies.

We take great care to avoid the nerves that control your voice. We also avoid the nearby glands (parathyroid glands) that control your blood calcium (kal-see-um) salts. We then close up the cut in the skin so that it heals with a barely visible scar.


Are there any alternatives?

If you leave things as they are, the thyroid problem remains. For an overactive gland, drug treatment will not work very well, or may cause a bad reaction in you. Pressure effects are likely to get worse. Any swelling will get more unsightly. The possibility of a tumour remains.


What happens before the operation?

Welcome to the ward

ward by the nurses or the receptionist. You will have ou will be asked to hand in any medicines or drugs you may be taking, so that your rug preparation rugs to prepare you for operation. This will be checked by the isits by the surgical team Surgeon, who will interview and examine you. isits by the anaesthetic team giving your anaesthetic will interview and isit by the physiotherapist w to keep your chest clear after the operation iet ill have your usual diet until 6-12 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during your operation. Drawing fluid out of a swelling gives relief only for a week or two. X-ray and laser treatment do not work. Sometimes a keyhole operation can be performed for a small thyroid swelling. W You will be welcomed to the your details checked. You will be shown to your bed and will be asked to change into your nightwear. You will have some basic tests done, such as pulse, temperature, blood pressure and urine examination. Y drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. D You may need special d Surgeon. V You will be seen first by the House He, or she, will arrange some special tests such as x-rays and blood samples. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this. V One or more anaesthetists who will be examine you. They will be especially interested in chest troubles, dental treatment and previous anaesthetics you have had, plus any anaesthetic problems in the family. V The physiotherapist will show you ho and how to keep moving about. You should not smoke. D You w Thyroidectomy Copyright M H Edwards 2007 Page 3 t the operation. it affecting the wound. the operation . The nurses will tell ou when to expect to go to the operating theatre. Do not be surprised, however, if ing. or tablets about 1 hour before the operation. tre tre orter. You will be wearing a cotton gown. Wedding rings will be fastened with tape. be left on the ward. There will be several checks on your the operation? Coming round lthough you will be conscious a minute or two after the operation ends, you are nlikely to remember anything until you are back in your bed on the ward. Some eration, but this passes off. You will er. You will have a dressing on the ound. The Periods The periods do not affec Shaving Excess hair will be shaved off to prevent Timing of The timing of your operation is usually arranged the day before y there are changes to the exact tim Premedication You may be given a sedative injection Transfer to thea You will be taken on a trolley to the operating suite by a ward nurse and a thea p Removable dentures will details on the way to the anaesthetic room where your anaesthetic will begin. You will go to sleep. The operation is then performed. What happens after after the anaesthetic A u patients feel a bit sick for up to 24 hours after op be given some treatment for sickness if necessary. You will have a drip tube in an arm vein. There will be a fine plastic tube coming out near the skin wound, connected to a plastic contain w You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. Warning after a General Anaesthetic Thyroidectomy Copyright M H Edwards 2007 Page 4 he drugs we give for a general anaesthetic will make you clumsy, slow and forgetful uite alright. Do not make any important decisions. Will it he wound is uncomfortable and you will have discomfort in your neck. Swallowing rtable. You will be given injections or pills for the pain. Ask for more et out of bed the day after operation despite the discomfort. ou will not do the wound any harm, and the exercise is very helpful for you. of bed. ou should be able to drink the day after operation provided you are not feeling sick. d. ll meals after 36 hours. is quite normal for the bowels not to open for a day or so after operation. le ask the urses for a laxative. is important that you pass urine and empty your bladder within 6-12 hours of the d using a bed pan or a bottle difficult, the nurses will assist you to ou will be offered painkillers rather than sleeping pills to help you to sleep. If you despite the painkillers please let the nurses know. he physiotherapist will check that you are clearing your lungs of phlegm by elp your circulation by continuous movement of body and limbs. T for about 24 hours. This happens even if you feel q For 24 hours after your general anaesthetic: hurt? T may be uncomfo if the pain is unpleasant. You will be expected to g Y The second day after operation you should be able to spend an hour or two out By the end of 3 days you should have little pain. Drinking and eating Y Then the arm drip is remove You should be able to take sma Opening bowels It If you have not opened your bowels after 2 days and you feel uncomfortab n Passing urine It operation. If you fin a commode or the toilet. If you still cannot pass urine let the nurses know and then steps will be taken to correct the problem. Sleeping Y cannot sleep Physiotherapy T coughing. You can h Thyroidectomy Copyright M H Edwards 2007 Page 5 he wound has a dressing which may show some staining with old blood in the first 4 hours. here may be some purple bruising around the wound which spreads downwards by is sprayed with a cellulose varnish which peels off after 7 to 10 days. rculation oing. wash the wound as soon as the clips have been removed. Soap and tap water re entirely adequate. Salted water is not necessary. You can wash or bathe the rest of ally. on, the nurses and doctors will keep your relatives and contacts up date with your progress. r your operation. out your home arrangements so that a proper time for notes, certificates etc. ave hospital The wound and stitches T 2 A thin plastic drain tube is removed when it stops draining - usually after 48 hours. T gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. There are metal clips in the skin which are removed 3 days after the operation. The wound Injections You will have tiny injections into the tummy skin twice a day to keep the ci g Washing You can a yourself norm What about informing my relatives and contacts? With your permissi to How long in hospital? Plan to go home 4 days afte The nurses will talk to you ab you to leave hospital can be arranged. Before you leave hospital you will be given an appointment for a check up visit one month after your operation. Sick notes Please ask the nurses for sick After you le Thyroidectomy Copyright M H Edwards 2007 Page 6 nd need rests 2 to 3 times a day for a week or more. riving ive as soon as you can make an emergency stop without hurting your neck hat about sex? elations within 2 or 3 weeks when the wound is comfortable ork uld be able to return to a light job after about 2 weeks, and any heavy job omplications nusual but are rapidly recognised and dealt with by the nursing you think that all is not well, please ask the nurses and doctors. ccasionally the wound swells due to a build up of blood in the neck in the 24 hours arely the voice is a little hoarse after the operation due to pulling on the nerves to the ometimes the calcium in your blood falls below normal in the hours and days after e do checks on your blood thyroxine and other chemicals in the months and years ometimes long term treatment is needed. We will tell you about this. hest infections may arise, particularly in smokers. Co-operation with the ound infection is a rare problem and settles down with antibiotics in a week or two. You are likely to feel very tired a You will gradually improve so that by the time 1 month has passed you will be able to return completely to your usual level of activity. D You can dr i.e. after about 2 weeks. W You can restart sexual r enough. W You sho within 4 weeks. C Complications are u and surgical staff. If O after operation. Rarely the wound needs to be re-examined in the operating theatre. R voice box. This will be discussed by the Surgeon. S the operation. This can give you a tingling feeling in your fingers or your lips. Tell the nurses or doctors and they will check your blood. You can have treatment for it, but mostly it settles down. W after the operation. S C physiotherapists to clear the air passages is important in preventing the condition. Do not smoke. W Thyroidectomy Copyright M H Edwards 2007 Page 7 ches and twinges may be felt in the wound for up to 6 months. ccasionally there are numb patches in the skin around the wound which get better ery rarely the thyroid becomes overactive again. We can test for this in he outpatient arely, extra treatment is needed. We will talk to you about this. eneral advice ll tolerated. Some patients, however, are surprised that they you have any problems or queries, please ask the nurses or doctors. ny Questions? ions, jot them down here and ask the doctors or nurses for ny complaints? nts, please contact the doctors or nurses straight away. If this ichael H Edwards cknowledgement A O after 2 to 3 months. V clinic. We will talk to you about this. R G The operation is we recover more slowly than expected but you should be back doing your normal duties within a month. If A If you have any quest answers. A If you have any complai does not solve the problem, please write to me at Ward 3, The Friarage Hospital, Northallerton. M Consultant Surgeon A Thyroidectomy Copyright M H Edwards 2007 Page 8 We gratefully acknowledge the generous support for the development and launching of SCALPEL Information Systems for patients, from: Northallerton Red Cross Society The crew of the Royal Fleet Auxiliary 'ARGUS' If you would like to help towards other ventures to benefit patients, please send donations to: The Chairman British Red Cross 62 Thirsk Road Northallerton DL6 1PN (Please make cheques payable to "British Red Cross") Thyroidectomy Copyright M H Edwards 2007 Page 9 Have you any comments? We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name. Full name: Hospital: Ward: Date of stay in hospital: Operation: Out patients department: Your admission arrangements: Your welcome on the ward: Nursing staff: General ward atmosphere: Medical staff: Ward orderlies: Portering staff: X-ray staff: ECG staff: Did you know who was who?: Bedding: Food and drink: Privacy: Locker space: Toilets: Bathrooms: Other patients: Noise: Information: Telephone/TV/radio/newspapers: Timing of operation: Preparations for your operation: Going into the theatre: In the operating theatre: In the recovery room: Coming back from theatre: Thyroidectomy Copyright M H Edwards 2007 Page 10 Intensive Care ward: Recovery on the ward: Pain control: Sleeping: Wound dressings: Stitches, clips: Progress reports: Visiting hours: Rest room: Tablets, medicines, injections: Going-home arrangements: Out-patient follow up: Anything else? Continue comments overleaf if you wish. Please send this questionnaire to Mr M Edwards, Ward 3, Friarage Hospital, Northallerton, North Yorkshire DL6 1JG.