Among the surgical interventions used on the thyroid gland , the following are distinguished: 1) enucleation of nodes, 2) thyroid resection ( resection volume is dictated by the nature of the disease and the degree of prevalence of the pathological process), 3) extirpation of the thyroid gland or one of its lobes, sometimes with regional lymph nodes.
Patients with toxic goiter due to the possibility of developing thyrotoxic heart - pronounced myocardial dystrophy, clinically accompanied by symptoms of heart failure, require special preoperative preparation aimed at improving the cardiovascular system, eliminating the clinical manifestations of thyrotoxicosis and preventing thyrotoxic crisis.
Thyroid surgery is most often performed under local anesthesia so that you can monitor the state of the voice during the operation. Modern endotracheal anesthesia can also be applied, which is indicated in operations in children, in patients with severe recurrent forms of goiter, and in people who are panicky afraid of the operation.Go
Within a few hours after surgery, patients should be in a semi-sitting position with their chin pressed to the chest. In the first two days after the operation, prescribed liquid food - broth, jelly, alkaline drink (Borjom); per os drugs only in the form of powders. Strict control of dressing, temperature, pulse and blood pressure is required. When soaking the bandage with blood, increasing the volume of the neck and difficulty breathing should be urgently notified to the surgeon on duty, since these symptoms may be due to bleeding and lead to asphyxiation . Hoarseness, difficulty coughing and choking when drinking indicate damage to the laryngeal nerve. In these cases, interventions should be directed to the prevention of aspiration pneumonia . Paresthesia , a positive symptom of the Tailstock (with slight tapping of the finger in the area between the zygomatic arch and the corner of the mouth, twitching of the muscles of the mouth, nose, eyelids) and cramps in the extremities can occur when the parathyroid glands are damaged or inadvertently, which requires the administration of calcium and parathyroidoid injection. Combined therapy of patients with thyrotoxicosis after the operation should include iodine microdoses, sedatives and drugs of the adrenal cortex ( hydrocortisone , prednisolone , dexamethasone), since adrenal insufficiency plays the main role in the development of thyrotoxic crisis. Thyrotoxic crisis often develops in the first two days after surgery and is characterized by severe tachycardia , sometimes with arrhythmia, a feeling of fever, a sharp rise in temperature, moisture of the skin, anxiety, rapid breathing, reddening of the face and an increase in pulse pressure, which can go up to 140-120 mmtr . st. (systolic pressure 180-120, and diastolic 40-0 mm Hg. Art.). To relieve a thyrotoxic crisis, 500-1,500 ml of 5% glucose solution is administered intravenously, together with water-soluble hydrocortisone (150 to 300 mg), novocainamide, 50% injection of analginum under the skin, cardiac agents. Timely measures are usually taken to remove the patient from the state of crisis.