Thyroidectomy

Thyroidectomy

Anesthesia type	General
Airway	Neuromonitoring ETT
Lines and access	PIV
Monitors	Standard 5-lead ECG Neuromonitoring
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative	Hypocalcemia Recurrent laryngeal nerve palsy
Article quality
Editor rating	In development
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A thyroidectomy is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

Preoperative management

Patient evaluation

System	Considerations
Airway	Large goiter can compress airway or cause vocal cord paralysis
Neurologic
Cardiovascular	Tachycardia, tachyarrhythmias
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine	Thyroid storm
Other

Labs and studies

• Thyroid studies
• BMP

Patient preparation and premedication

N/A

Regional and neuraxial techniques

N/A

Intraoperative management

Monitoring and access

• Standard ASA monitors
• IONM (intra operative nerve monitoring) for recurrent laryngeal nerve

Induction and airway management

• NIMS endotracheal tube (for neuro monitoring)
• Video laryngoscope for surgeons to ensure proper electrode placement

Positioning

• Supine

Maintenance and surgical considerations

• Avoid paralysis
• Consider remifentanil instead

Emergence

• Avoid bucking/coughing
  • Consider deep extubation
  • Consider leaving remi on

Postoperative management

Disposition

• PACU, stay in hospital

Potential complications

• Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.
• Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy
• Hypocalcemia

Procedure variants

	Variant 1	Variant 2
Unique considerations	Open thyroidectomy	Transoral thyroidectomy (minimally invasive)
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications