From the Guidelines
Post-operative care for patients undergoing parathyroidectomy or thyroidectomy should prioritize monitoring for complications, such as hematoma formation, and managing symptoms, with a focus on preventing morbidity, mortality, and improving quality of life.
Key Considerations
- Monitoring for signs of hematoma, such as difficulty breathing, agitation, anxiety, and discomfort, is crucial in the post-operative period, as recommended by the study published in Anaesthesia 1.
- Patients should be closely observed for signs of hypocalcemia, especially after parathyroidectomy, and calcium levels should be checked regularly, with oral calcium supplements prescribed prophylactically if necessary.
- Voice changes should be monitored as recurrent laryngeal nerve injury can occur, and pain management typically includes acetaminophen and possibly mild opioids for 3-5 days.
- Incision care involves keeping the wound clean and dry, with suture removal in 7-10 days if non-absorbable sutures were used.
- Patients should avoid strenuous neck movements and heavy lifting for 1-2 weeks.
Specific Recommendations
- For thyroidectomy patients, thyroid hormone replacement should begin immediately and be adjusted based on thyroid function tests 6-8 weeks post-surgery.
- Patients should be educated about signs of infection and respiratory distress, and follow-up appointments should be scheduled at 1-2 weeks post-surgery to assess wound healing and hormone levels.
- A post-thyroid surgery emergency box should be available at the bedside, including emergency front-of-neck airway equipment, and staff should be trained to recognize hematoma and manage airway compromise, as outlined in the study published in Anaesthesia 1.
Prioritizing Patient Safety
- Immediate senior surgical review should be arranged if there are concerns about potential hematoma, and a systematic approach should be taken to open the wound at the bedside if signs of airway compromise occur.
- The SCOOP approach (skin exposure, cut sutures, open skin, open muscles, pack wound) is recommended for emergency hematoma evacuation, as described in the study published in Anaesthesia 1.
From the Research
Post-Operative Care for Parathyroidectomy and Thyroidectomy
- The primary goal of post-operative care for patients undergoing parathyroidectomy or thyroidectomy is to prevent and manage hypocalcemia, a common complication of these surgeries 2, 3, 4.
- Studies have shown that postoperative parathyroid hormone (PTH) testing can help identify patients at risk for hypocalcemia and allow for early supplementation therapy, reducing the risk of symptomatic hypocalcemia and associated emergency room visits 2, 4.
- The use of calcium and vitamin D supplements in the postoperative period may reduce the risk of symptoms, temporary hypocalcaemia, and hospital stay, but may also lead to overtreatment and has no effect on long-term hypoparathyroidism 5.
- Preoperative calcitriol treatment has been shown to reduce postoperative intravenous calcium requirements and length of stay in patients undergoing subtotal parathyroidectomy for renal-origin hyperparathyroidism 6.
Management of Post-Operative Hypocalcemia
- Patients with postoperative PTH levels <10 pg/mL are at higher risk for hypocalcemia and may benefit from prophylactic treatment with calcitriol and calcium 4.
- The use of predictable criteria, such as postoperative PTH levels and serum calcium levels, can help identify patients at risk for symptomatic hypocalcemia and guide selective calcium supplementation 3.
- Recombinant parathyroid hormone may also be a potential treatment option for managing post-thyroidectomy hypoparathyroidism, but further research is needed to evaluate its effectiveness 5.
Hospital Stay and Emergency Room Visits
- Studies have shown that postoperative PTH testing and early supplementation therapy can reduce the length of hospital stay and the number of emergency room visits for patients undergoing thyroidectomy or parathyroidectomy 2, 4, 6.
- The use of preoperative calcitriol treatment has also been shown to reduce the length of hospital stay in patients undergoing subtotal parathyroidectomy for renal-origin hyperparathyroidism 6.