From the Guidelines
After a total thyroidectomy, it is crucial to closely monitor patients for signs of hematoma formation, which can occur within the first 24 hours, with approximately half of cases occurring within 6 hours, as stated in the study by 1.
Postoperative Monitoring
The following should be observed in the postoperative period:
- Haematoma formation, which presents as neck swelling, pain, or difficulty breathing and requires immediate intervention
- Vital signs, particularly for fever which could indicate infection
- Vocal cord function by evaluating voice quality and watching for hoarseness, which may indicate recurrent laryngeal nerve injury
- Signs of hypocalcemia, such as perioral numbness, tingling in fingers and toes, muscle cramps, and positive Chvostek's or Trousseau's signs
Frequency of Observations
According to the study by 1, routine patient observations should be carried out at least hourly for the first 6 hours postoperatively, and the frequency of observations may be tailored according to individual patient risk and local policies after the initial 6-hour period.
Nursing Care
Patients should be preferentially nursed in a bed where they can easily attract the attention of nursing staff, and staff should be aware of signs that may suggest a need for an increase in the required frequency of observations, as recommended by 1.
Minimum Monitoring
Minimum monitoring should include:
- Wound inspection
- Early warning score (respiratory rate; heart rate; blood pressure; temperature; arterial oxygen saturations; Glasgow Coma Scale)
- Pain score
- Awareness for more subtle signs (agitation; anxiety; difficulty in breathing; discomfort), as stated in the study by 1.
From the Research
Post-Operative Observations in Total Thyroidectomy
- Hypocalcemia is the most common complication following total thyroidectomy, and its prevention and management are crucial in the post-operative period 2, 3, 4, 5, 6
- Patients undergoing total thyroidectomy should be monitored for signs and symptoms of hypocalcemia, such as tingling, numbness, and muscle cramps 2, 3, 4
- Laboratory results, including calcium and parathyroid hormone levels, should be closely monitored to detect any abnormalities 2, 4, 6
- The use of perioperative or postoperative calcium and vitamin D supplementation can significantly reduce the risk of symptomatic and biochemical hypocalcemia 2, 3, 4, 5, 6
- A tapering course of calcium carbonate postoperatively can be an effective and cost-effective method of preventing and managing postoperative hypocalcemia 3
- Pre-operative treatment with calcium, vitamin D, or both can also reduce the risk of post-operative hypocalcemia 5
- The combination of calcium and vitamin D supplementation is more effective than calcium alone in preventing postoperative hypocalcemia and decreasing the demand for intravenous calcium supplementation 6
Key Considerations
- The incidence of symptomatic hypocalcemia can be significantly lower in patients receiving perioperative or postoperative calcium and vitamin D supplementation 2, 4, 5, 6
- The recovery period of symptomatic hypocalcemia can be shortened to within 24 hours with perioperative supplementation 2
- The cost of calcium carbonate supplementation is relatively low, making it a cost-effective method of preventing and managing postoperative hypocalcemia 3