Question

Case Study: The Patient with Endocrine Problems

The nurse is caring for a 41-year-old woman who is the mother of two small children. She states that she has felt “nervous and tired” for approximately 1 month. Today, she has had a sudden onset of breathlessness with cardiac palpitations. She states, “I have not been feeling well for about a month, but when I felt breathless I thought I should be checked out.” Upon further questioning, the nurse finds that the woman also has had an unexplained loss of weight of approximately 30 lbs over 3 months, frequent loose stools, loss of hair on the scalp, and a feeling of “burning up.”

If surgical intervention is necessary, what preoperative care would the nurse anticipate?

If surgical intervention is employed what surgery would be preferred? Identify the appropriate postoperative care for this patient.

Answer 1

This is A Case of Hyperthyroidism as Suggested by patients Symptoms-

• Nervous
• Breathlessness
• Palpitations
• Unexplained Weight loss
• Frequent loose Stools
• Feeling of "Burning Up"
• Loss of Hair on scalp

The pre-operative Care these patients Are-

Saturated solution of potassium iodide (SSKI) or potassium iodine (Lugol's solution), given for a short period prior to surgery, in order to reduce both thyroid hormone release and thyroid gland vascularity, is beneficial to decrease intra-operative blood loss.

Other options to Saturated Solution of Iodine is plasmapheresis, lithium or cholestyramine. Adequate preoperative preparation reduces chances of intraoperative and immediate postoperative adverse events.

If surgical Intervention is Employed the Surgery done for this patient is -

For certain types of hyperthyroidism, such as from a solitary toxic adenoma, surgery entails partial removal of the half of your thyroid gland (known as a lobectomy) with the adenoma. For nearly all other types of hyperthyroidism, including Graves' disease, Toxic MultiNodular goitre and Non-toxic goitre the surgery is a nearly total thyroidectomy.

Appropriate Post-Operative Care for these patients Are-

1. Swallowing and diet: Patient may feel initial discomfort with swallowing for several weeks after surgery which usually resolves with time. Eat soft foods in the beginning then progress to a normal diet.
2. Pain medication: Moderate pain and discomfort is expected for the first postoperative week. You will be given Tylenol with codeine as a pain medication.
3. Thyroid medication: If a total thyroidectomy has been performed (your entire thyroid was removed) then you will be placed on thyroid replacement medication.
4. Calcium medication: Frequently the calcium level can drop after a total thyroidectomy. Calcium replacement with Calcium Carbonate pills (tums) or Calcium Carbonate with vitamin D (OsCal) is recommended at about 6 pill per day.
5. Radioactive Iodine: If you have the diagnosis of thyroid cancer you will sometimes be given an appointment with a Radiation Oncologist who will administer I131 which is a radioactive iodine that eliminates any microscopic thyroid cancer cells.
6. Wound care: The patient's suture will be removed eight days after surgery. Make an appointment in my office for the following week after surgery. For several weeks there may be some redness to the wound and some swelling at the top half of the neck.
7. Activity: The patient may resume his normal activity about 4-5 days after surgery. Normal bathing can be resumed 2 days after surgery. As you feel comfortable you can resume you normal routine.