Thyroidectomy Study Notes
Complications after surgery
Recurrent laryngeal nerve injury: Can cause hoarseness, weak voice, coughing/choking
when swallowing, or even airway obstruction if both nerves are damaged.
Hypocalcemia: Damage or removal of parathyroid glands may lead to low calcium →
tingling, muscle cramps, tetany.
Hemorrhage/hematoma: Neck swelling, difficulty breathing, stridor. This is a surgical
emergency.
Infection: Redness, fever, drainage at incision site.
Thyroid storm (rare): If residual thyroid tissue is hyperactive, symptoms include
tachycardia, fever, hypertension.
Positioning
Semi-Fowler’s position: Head of bed elevated 30–45° to reduce edema and tension on the
suture line.
Neck support: Pillows behind the neck/shoulders; avoid hyperextension or flexion.
Arms tucked and padded: Prevents strain and maintains comfort during recovery.
Monitoring measures
Airway patency: Watch for stridor, dyspnea, or sudden swelling at the neck.
Voice changes: Ask patient to speak; hoarseness may indicate nerve injury.
Calcium levels: Monitor for hypocalcemia symptoms (numbness, tingling, muscle
spasms).
Vital signs: Especially heart rate and blood pressure for early signs of bleeding or thyroid
storm.
Incision site: Check for bleeding, swelling, or infection.
Drain output: If present, measure and record.
📝 Study Table
Focus Area Key Points
Complications Nerve injury, hypocalcemia, bleeding, infection, thyroid storm
Positioning Semi-Fowler’s, neck supported, avoid strain
Monitoring Airway, voice, calcium, vitals, incision, drains
,Key Symptoms of Cushing’s Syndrome
Weight gain in trunk with thin arms/legs: Central obesity is a hallmark sign.
Moon face: Rounded, red face due to fat redistribution.
Buffalo hump: Fatty lump between the shoulders.
Purple stretch marks: Wide striae on abdomen, hips, thighs, breasts, and underarms.
Thin, fragile skin: Easy bruising and poor wound healing.
Acne: Cortisol excess can worsen skin conditions.
Hirsutism in women: Excess facial/body hair; menstrual irregularities.
Sexual dysfunction in men: Low libido, erectile dysfunction, reduced fertility.
Muscle weakness: Especially in proximal muscles (hips, shoulders).
Extreme fatigue: Persistent tiredness despite rest.
Mood changes: Depression, anxiety, irritability, poor concentration.
High blood pressure: Cortisol raises vascular tone.
Bone loss/osteoporosis: Increased fracture risk.
Slow growth in children: Cortisol excess stunts development.
Frequent infections: Cortisol suppresses immunity.
Sources:
📊 Study-Friendly Symptom Table
Category Examples
Appearance changes Moon face, buffalo hump, central obesity, purple striae
Skin changes Fragile skin, easy bruising, acne, poor wound healing
Musculoskeletal Muscle weakness, bone loss, fractures
Reproductive Women: hirsutism, irregular periods; Men: low libido, erectile dysfunction
Psychological Depression, anxiety, irritability, poor memory
Metabolic Hypertension, diabetes, infections, fatigue
Children Obesity, slowed growth
, Addison’s Disease
Symptoms
Fatigue and weakness: persistent tiredness, muscle weakness.
Weight loss and loss of appetite: unintentional weight loss.
Hyperpigmentation: dark patches on skin, gums, scars.
Low blood pressure: dizziness, fainting, especially when standing.
Salt craving: due to low aldosterone.
GI symptoms: nausea, vomiting, diarrhea, abdominal pain.
Mood changes: irritability, depression, poor concentration.
Hypoglycemia: low blood sugar, sweating, confusion.
Menstrual changes in women: irregular periods, loss of body hair, decreased libido.
Treatment
Hormone replacement therapy:
o Cortisol → hydrocortisone (oral, 2–3 times daily).
o Aldosterone → fludrocortisone (helps balance sodium/potassium).
Stress dosing: higher doses during illness, surgery, trauma.
Lifestyle precautions: carry medical alert bracelet, emergency cortisol injection kit,
increase salt intake in hot weather/exercise.
Monitoring: avoid over-treatment (risk of obesity, diabetes, osteoporosis).
🚨 Addisonian Crisis (Adrenal Crisis)
Symptoms
Severe weakness and fatigue.
Sudden severe pain in lower back, abdomen, or legs.
Severe vomiting and diarrhea → dehydration.
Low blood pressure → shock, fainting.
Confusion or loss of consciousness.
Fever, rapid heart rate, rapid breathing.
Electrolyte imbalance: low sodium, high potassium, low blood sugar.
Treatment
Immediate IV hydrocortisone: replaces cortisol.
IV saline with dextrose: restores fluids, electrolytes, and blood sugar.
Antibiotics if infection is the trigger.
Emergency plan: patients should carry injectable cortisol and teach family/friends how to
administer it.
Complications after surgery
Recurrent laryngeal nerve injury: Can cause hoarseness, weak voice, coughing/choking
when swallowing, or even airway obstruction if both nerves are damaged.
Hypocalcemia: Damage or removal of parathyroid glands may lead to low calcium →
tingling, muscle cramps, tetany.
Hemorrhage/hematoma: Neck swelling, difficulty breathing, stridor. This is a surgical
emergency.
Infection: Redness, fever, drainage at incision site.
Thyroid storm (rare): If residual thyroid tissue is hyperactive, symptoms include
tachycardia, fever, hypertension.
Positioning
Semi-Fowler’s position: Head of bed elevated 30–45° to reduce edema and tension on the
suture line.
Neck support: Pillows behind the neck/shoulders; avoid hyperextension or flexion.
Arms tucked and padded: Prevents strain and maintains comfort during recovery.
Monitoring measures
Airway patency: Watch for stridor, dyspnea, or sudden swelling at the neck.
Voice changes: Ask patient to speak; hoarseness may indicate nerve injury.
Calcium levels: Monitor for hypocalcemia symptoms (numbness, tingling, muscle
spasms).
Vital signs: Especially heart rate and blood pressure for early signs of bleeding or thyroid
storm.
Incision site: Check for bleeding, swelling, or infection.
Drain output: If present, measure and record.
📝 Study Table
Focus Area Key Points
Complications Nerve injury, hypocalcemia, bleeding, infection, thyroid storm
Positioning Semi-Fowler’s, neck supported, avoid strain
Monitoring Airway, voice, calcium, vitals, incision, drains
,Key Symptoms of Cushing’s Syndrome
Weight gain in trunk with thin arms/legs: Central obesity is a hallmark sign.
Moon face: Rounded, red face due to fat redistribution.
Buffalo hump: Fatty lump between the shoulders.
Purple stretch marks: Wide striae on abdomen, hips, thighs, breasts, and underarms.
Thin, fragile skin: Easy bruising and poor wound healing.
Acne: Cortisol excess can worsen skin conditions.
Hirsutism in women: Excess facial/body hair; menstrual irregularities.
Sexual dysfunction in men: Low libido, erectile dysfunction, reduced fertility.
Muscle weakness: Especially in proximal muscles (hips, shoulders).
Extreme fatigue: Persistent tiredness despite rest.
Mood changes: Depression, anxiety, irritability, poor concentration.
High blood pressure: Cortisol raises vascular tone.
Bone loss/osteoporosis: Increased fracture risk.
Slow growth in children: Cortisol excess stunts development.
Frequent infections: Cortisol suppresses immunity.
Sources:
📊 Study-Friendly Symptom Table
Category Examples
Appearance changes Moon face, buffalo hump, central obesity, purple striae
Skin changes Fragile skin, easy bruising, acne, poor wound healing
Musculoskeletal Muscle weakness, bone loss, fractures
Reproductive Women: hirsutism, irregular periods; Men: low libido, erectile dysfunction
Psychological Depression, anxiety, irritability, poor memory
Metabolic Hypertension, diabetes, infections, fatigue
Children Obesity, slowed growth
, Addison’s Disease
Symptoms
Fatigue and weakness: persistent tiredness, muscle weakness.
Weight loss and loss of appetite: unintentional weight loss.
Hyperpigmentation: dark patches on skin, gums, scars.
Low blood pressure: dizziness, fainting, especially when standing.
Salt craving: due to low aldosterone.
GI symptoms: nausea, vomiting, diarrhea, abdominal pain.
Mood changes: irritability, depression, poor concentration.
Hypoglycemia: low blood sugar, sweating, confusion.
Menstrual changes in women: irregular periods, loss of body hair, decreased libido.
Treatment
Hormone replacement therapy:
o Cortisol → hydrocortisone (oral, 2–3 times daily).
o Aldosterone → fludrocortisone (helps balance sodium/potassium).
Stress dosing: higher doses during illness, surgery, trauma.
Lifestyle precautions: carry medical alert bracelet, emergency cortisol injection kit,
increase salt intake in hot weather/exercise.
Monitoring: avoid over-treatment (risk of obesity, diabetes, osteoporosis).
🚨 Addisonian Crisis (Adrenal Crisis)
Symptoms
Severe weakness and fatigue.
Sudden severe pain in lower back, abdomen, or legs.
Severe vomiting and diarrhea → dehydration.
Low blood pressure → shock, fainting.
Confusion or loss of consciousness.
Fever, rapid heart rate, rapid breathing.
Electrolyte imbalance: low sodium, high potassium, low blood sugar.
Treatment
Immediate IV hydrocortisone: replaces cortisol.
IV saline with dextrose: restores fluids, electrolytes, and blood sugar.
Antibiotics if infection is the trigger.
Emergency plan: patients should carry injectable cortisol and teach family/friends how to
administer it.
