UNIVERSIDAD DE MANILA
(Formerly City College of Manila)
Mehan Gardens, Manila
College of Nursing
“ Thyroid Lobectomy”
Mae Anne A. Anggo
Ma. Kathleen F. Balingit RN, MAN
Thyroid Lobectomy is an operation to remove one half (a lobe) of the thyroid gland. This simply means removal of a thyroid lobe and the isthmus (the part that connects the 2 lobes). This removes more thyroid tissue than a simple lobectomy, and is used when a larger margin of tissue is needed to assure that the "problem" has been removed. Appropriate for those indications listed under thyroid lobectomy as well as for Hurthle cell tumors, and some very small and non-aggressive thyroid cancers.
Operative time: usually 45 minutes to 1 hour.
Anesthesia: General anesthesia is used.
Hospital stay: usually day surgery
-Thyroid cancer (non-aggressive cancer)
-Goiter (an overall enlargement, unilateral non toxic goiter/ isolated to one lobe) -Hyperthyroidism (the production of too much hormone)
-Thyroid Nodules (a localized enlargement, are growth of cells in the thyroid gland)
Laboratory and Diagnostic exam
-Physical assessment- The physical examination includes checking the thyroid gland for possible enlargement (commonly called a goiter), its adjacent lymph nodes for any pain, tenderness and swelling, and the nodule itself for consistency, size and texture. If the nodule is soft, smooth and mobile, chances are the nodule is benign. If the nodule is firm, hard, irregular and fixed, the nodule may be malignant -Serum Ca and PH level
-CT scan- to help detect and diagnose a goiter, or larger thyroid nodules. -Serum PTH- It is ordered to help diagnose the reason for a low or high calcium level and to help distinguish between parathyroid-related and non-parathyroid-related causes. It may also be ordered to monitor the effectiveness of treatment when a patient has a parathyroid-related condition. A calcium test is almost always ordered along with a PTH test. It is not just the levels in the blood that are important, but the balance between them and the response of the parathyroid glands to changing levels of calcium. Usually doctors are concerned about either severe imbalances in calcium regulation that may require medical intervention or in persistent imbalances that indicate an underlying problem. -MRI( Magnetic Resonance Imaging) – to evaluate the size and shape of the thyroid
* If calcium levels are low and PTH levels high, then the parathyroid glands are responding as they should and producing appropriate amounts of PTH. Depending on the degree of hypocalcemia, a doctor may investigate a low calcium level further by measuring vitamin D, phosphorus, and magnesium levels. * If calcium levels are low and PTH levels are normal or low, then PTH is not responding and the person tested probably has hypoparathyroidism. Hypoparathyroidism is a failure of the parathyroid glands to produce sufficient PTH. It may be due to a variety of conditions and may be persistent, progressive, or transient. Causes include an autoimmune disorder, parathyroid damage or removal during surgery, a genetic condition, and severe illnesses. Those affected will generally have low PTH levels, low calcium levels, and high phosphorus levels.
Before the Operation
-Consent form/ “Informed Consent”- This information must be read completely before signing the surgical consent form. (regarding the risks and benefits of the procedure). -NPO- the anesthesiologist will instruct you to have nothing per orem at least six hours before surgery, the reason why an empty stomach is required is because os Mendelsons syndrome ( aka aspiration pneumonia ) during induction of general anesthesia there is a short period where the airway is unprotected if there is reflux of gastric contents, this occurs after the patient has slept and before the trachea is intubated ( tube in...