甲状腺切除手术 (THYROIDECTOMY)

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		Notes Bad reactions to the anesthesia THYROIDECTOMY  Your Body The goal of a thyroidectomy is to treat your condition by removing all or part of thethyroid gland. This operation is an excellent way to treat, or begin treating, several thyroid problems. The thyroid is in the front part of your neck, just below your voice box (larynx). It's shaped a little like a butterfly. The butterfly's wings are the right and left lobes. The lobes wrap around your windpipe. Nerves that control your vocal cords and voice box run alongside your windpipe. On the back side of your thyroid are the parathyroid glands. They control calcium levels in your body. Bean-shaped things called lymph nodes carry a fluid called lymph as it moves through your lymphatic system, which runs all over your body. What does the thyroid gland do?  The thyroid uses iodine from your blood to make a hormone that controls how your body uses energy (or your metabolism). So it helps control things like how many calories you burn, your body temperature, and menstrual cycles (or when you get your period). Your thyroid hormone level needs to be balanced so your body works as it should. Too much or too little thyroid hormone in your blood can throw your system out of balance and cause all kinds of problems. You can live without a thyroid gland. Even if your entire thyroid gland is removed, taking daily medication can get thyroid hormone into your system. In fact, you may already take medicine to keep your thyroid hormone level in a healthy range. Your Condition Some thyroid conditions are more likely to need surgery than others. But some of the most common conditions that need to be treated with this operation are: Nodules (lumps) Goiters Hyperthyroidism Thyroid cancer Nodules Nodules are lumps inside the thyroid gland. They're pretty common, and anyone can get them. Most of the time, nodules don't cause any problems. And if a harmless nodule is found, your doctor may decide to just leave it alone. But you may need surgery if a nodule is: Getting bigger Pressing against structures in your neck (like your windpipe) Your doctor thinks it may be thyroid cancer If you have a nodule, before the operation, your doctor will most likely do something called a fine needle aspiration (also called an FNA or biopsy). In fact, you may have already had this. Usually, a fine needle aspiration is done to remove a few cells so they can be looked at under a microscope to make sure cancer isn't there. Goiter When the entire thyroid gland gets bigger it's called a goiter. Like nodules, goiters don't always have to be removed. But if a goiter is causing problems with swallowing or breathing, or if it's big and your doctor thinks it should come out, surgery may be done to remove it. Doctors often don't know of any one cause for goiters. But they may be caused by a combination of things, including: Family history Exposure to radiation at some point in your life You don't get enough iodine The thyroid is making too little or too much thyroid hormone HypothyroidismWhen the thyroid makes too little hormone, it's called hypothyroidism. Surgery is notneeded to treat this. Hyperthyroidism When it makes too much hormone it's called hyperthyroidism. Surgery may be done for this. Hyperthyroidism speeds up your metabolism and causes your body to use energy too fast, and this can make you feel jittery, irritable, lose weight, or have trouble sleeping. The thyroid isn't always removed to treat hyperthyroidism. But when medication or other things like radioactive iodine treatments don't work to control hyperthyroidism, all or part of the thyroid may need to be removed. Thyroid cancerAs you know, our bodies are made up of billions of cells. In a healthy body, cells grow, divide, and eventually die. And as old cells die off, they're constantly replaced by new ones. Cancer happens when abnormal cells continue to multiply. And a lump of tissue called a tumor can form. The most common, and most treatable, type of thyroid cancer is something calledpapillary thyroid carcinoma. This kind of cancer tends to grow slowly, and usually is NOT life threatening. In fact, it has a very high cure rate. But there aren't many things scarier than cancer, no matter how treatable it is. So if you've been diagnosed with thyroid cancer, talk with your doctor about the type you have. Before Surgery Before surgery, you'll probably have a few more tests. You'll most likely have a physical exam that may include things like: A blood test Imaging tests like an ultrasound or CT scan An EKG to check out your heart It's also very important for your surgeon to learn about your overall health and your health history. And it's up to you to fill her in. Think of yourself as a key member of your healthcare team. When you give your doctor the information she needs, you increase your chance for success. Let your surgeon know if: You have any health conditions You're allergic to anything (like penicillin or latex) You or anyone in your family has ever had a bad reaction to anesthesia There's any chance at all you may be pregnant For your safety, make a list of everything you take. Be sure to include: All prescription and over-the-counter drugs Herbal supplements Vitamins Recreational drugs You may need to get some medications out of your system in the weeks before surgery.  For instance, your doctor may ask you to temporarily stop taking anything that can increase the risk of bleeding. This includes things like: Aspirin Anti-inflammatory drugs like Advil®, Motrin®, or any arthritis medication Herbs like Ginkgo biloba If you take a blood thinner like warfarin (also called Coumadin®) or drug called Plavix®, you'll need to talk to the doctor who put you on this drug to find out exactly what to do. But do not stop taking this kind of medication on your own. Your doctor needs to help you do this safely. For a complete list of what to stop taking, and when, ask your doctor. It's also important to know which medications you should KEEP taking.  If you take medication now for things like high blood pressure, make sure you talk with your doctor about this. Support It's a good idea to ask a family member or a friend to be there with you for comfort and support. Think of this person as your partner in care. Doctors and nurses like to have one "go to" person for all communication. He or she should be able to speak up for you, ask questions, and give information about your health. Be sure to introduce this person to your doctors and your nurses so they know it's OK to share your health information with them. The night before surgery One thing that's VERY important, do NOT eat or drink anything after midnight. If there's anything in your stomach and you throw up during the operation, it can be very dangerous. So make sure your stomach is EMPTY, or your surgery may need to be rescheduled. That said, if your doctor says it's OK to take some or all of your regular medications on the morning of surgery, just take it with a sip of water.   Your Procedure Your surgeon will have a specific plan for your operation and recovery. But this will give you a general sense of how surgery will go. First, an IV line will be placed in your hand or your arm. This is so you can receive antibiotics, medication, and fluids. Then you'll go to the operating room. When you get there, you may be connected to: Monitors that measure your blood pressure and heart rate A pulse oximeter will be placed on your finger to measure the oxygen in your blood Compression boots to help lower the risk of blood clots in your legs Anesthesia Then they'll start your anesthesia, which can be given a couple of ways. You may have a combination of medicine to numb your neck, and medication that will make you very drowsy. This is called conscious sedation. The medicine won't put you to sleep completely. But you probably won't remember anything that happens during surgery. General Anesthesia Many times, this surgery is done under general anesthesia, which puts you into a deep sleep, so you're completely out. An oxygen mask is placed over your mouth and nose, and you'll be asked to take deep breaths. Then you'll get the anesthesia through your IV. The medication may sting or burn a little bit when it goes in, but don't worry, that's normal. Very quickly, you'll fall asleep. After this, you really won't remember anything about the procedure. Once you're asleep, a tube is placed in the back of your throat or down your windpipe to help you breathe. You won't feel the tube going in or coming out. But when you wake up, your throat may feel a little sore. And even though this operation is on your neck, the tube won't get in your surgeon's way during the operation. The Procedure When everything is ready, surgery can begin. It usually takes anywhere from 1 to 3 hours. Your surgeon will start by making a 2 to 4 inch opening in your neck. Then she'll spread the skin and muscle to see the thyroid gland. Next she'll carefully remove part of the thyroid. But if she needs to, your surgeon may remove the entire thyroid gland. How much of the thyroid is removed depends on your condition and what your surgeon thinks is best. If your operation is for thyroid cancer, your surgeon may remove a few lymph nodes as well. If cancer cells spread, they often travel through the nodes first. So your surgeon may remove a few or all of the nodes to see if cancer has spread to them. Then the cut is closed with stitches that go under the skin and surgical tape. And the wound is covered with a small bandage. A tube may be placed in your neck to drain any fluid that may collect there after surgery. If a tube is placed, it will most likely be taken out before you go home.   After Surgery After surgery, expect to feel groggy and a little out of it. If you feel sick to your stomach or have the chills, just ask your nurse to help you get comfortable. In recovery You'll be hooked up to some monitors and your IV line for medication and fluids. After a couple of hours, a nurse will help you get up and walk. Moving around can help prevent blood clots from forming in your legs and helps you regain strength. Most people are surprised by how well they feel right after surgery. In fact, a lot of people are able to walk around and eat normally the same day as their operation. Going home Some people go home the same day as their surgery. But many people stay for a night. Once your doctor thinks you're ready, you can go home. Just make sure you have someone to drive you home and stay with you. In fact, you may not be able to drive for a while. If you have any questions about when it's safe for you to drive again, ask your doctor. When I get home, will I be in a lot of pain? Many people say the pain isn't too bad. But for the first few days after surgery you may have: Pain, swelling, or bruising around your wound A sore throat Muscle aches or stiffness in the back of your neck and in your shoulders Your doctor will prescribe pain medication if you need it. But some people only feel like they need to take over-the-counter drugs like Tylenol® for their discomfort. In fact, some people don't need to take any medication at all. Just make sure you understand your doctor's instructions on how and when to take any medications. Bathing Your doctor may tell you not to shower for a day or so after surgery. To prevent infection, she'll most likely tell you not to go swimming or take baths until your cut is healed over. After you get the OK to shower, just pat your cut dry with a towel when you're done. If you have any questions about this, ask your doctor. Returning to work and other activities You should be able to return to work in about a week. But it could be sooner or later. It just depends on how well you feel and what kind of job you have. You'll most likely feel good enough to do many of your normal activities in a few days to a week. Just don't push yourself too hard in the first couple of days. One thing you should do is move your neck from side to side. Rolling your shoulders is good, too. Gentle stretches like these should help prevent stiffness. Of course, if you have any problems during recovery, please call your surgeon. Call right away if you have: A fever of 101°F or higher Severe pain that does NOT get better with medication Sudden shortness of breath or chest pain Bleeding that soaks your bandage Pain, swelling, or fluid leaking from your cut Difficulty breathing or you can't swallow food or liquid Also call if you have: Muscle twitches or cramping in your feet, hands, or face Numbness around your mouth Tingling in your fingers, toes, or lips It's normal to have MILD numbness and tingling in these areas. But if it's severe, call your doctor. Or call if you experience anything unusual. If something just feels wrong, let your doctor know. Thyroid replacement therapy Depending on how much of your thyroid is removed, you may need to take medication after surgery that will do the job of your thyroid gland. This is called thyroid replacement therapy. Thyroid replacement is typically a pill you take once a day that has the exact same chemical makeup as the hormone your thyroid makes. And you may have to take a pill daily for the rest of your life. Most of the time, people who need thyroid replacement pills start taking them soon after surgery. In fact, you may have been taking them before surgery to try treating your condition. If your entire thyroid is removed, you'll definitely need to begin thyroid replacement therapy. If only half of your thyroid is taken out, you may or may not need to take medication. TSH test It may take a little while before the hormone level in your system is right. So about 6 weeks after surgery you'll have a simple blood test called a thyroid-stimulating hormone (TSH) test. A TSH test lets your doctor figure out how much thyroid medicine you need by seeing if there's too much or too little TSH in your blood. If your dosage is adjusted, your blood will be tested again in another 6 to 8 weeks to see if your TSH is balanced. If it is, you're getting the right amount of thyroid medication. It may take a few adjustments before the hormone level is balanced. But once it is, you'll most likely have a TSH test once a year. With balanced hormone levels, you shouldn't have any problems with weight gain or low energy, but if you have questions about this ask your doctor. Risks and Benefits Benefits How this surgery benefits you depends on your condition. A thyroidectomy usually works to cure conditions like nodules, goiters, or hyperthyroidism. If you have thyroid cancer, this operation may be enough to cure it. Or it could be an important first step in treating your condition and finding out how advanced the cancer is (or the cancer's stage). And your doctor can decide whether other treatments need to be done afterward. Risks Like any operation, a thyroidectomy has some risks. Below are some of the risks of this operation, but this isn't meant to scare you. Understanding what's involved is an important part of any operation. If you have any questions about how these risks relate to you, please ask your doctor. Also, there are some very unusual risks that will not be covered here. So please do not consider this list complete. There is a risk of injury to the nerves that control your vocal cords. An injury may cause a hoarse-sounding voice, trouble swallowing, or trouble breathing. Any problems may go away in the weeks after surgery, but sometimes they can be permanent. Because your surgeon needs to work very close to the nerves that control your vocal cords, there's a risk a nerve in this area could be stretched or injured. This may cause a weak or hoarse-sounding voice. You also may not be able to project your voice as well, or hit high notes when you sing. Sometimes, it may be harder to swallow food, drink, or pills. And although seriuos breathing problems are rare, sometimes people get short of breath, have noisy breathing, or trouble coughing. So keep your doctor up to date. She may suggest other procedures to help with any problems. And of course, if you have serious trouble breathing, get emergency help right away. Most of the time, these problems are temporary and go away within 6 months. But in some cases, these problems can be permanent.There is a risk that the parathyroid glands may be injured or removed during the operation. In some cases, you may need to take calcium pills (possibly every day) for the rest of your life. Even though the goal of this surgery is to remove all or part of the thyroid gland, there is a risk that the parathyroid glands (which control calcium levels in your blood) may be removed as well. Or they may be injured. The parathyroid glands are very small, and are often difficult for the surgeon to see. So if the parathyroid glands are removed or injured, calcium in your blood may drop to a low level. If this happens, it may cause: Numbness around your mouth Tingling in your fingers, toes, or lips Muscle twitches or cramping in your feet, hands, or face If calcium levels are low after surgery, it's usually temporary and can be treated with high doses of vitamin D and calcium medication. But in very rare cases, you may need to take daily medication for the rest of your life.There is a risk of bleeding both during and after surgery. In rare cases, another operation may be needed to treat any bleeding. With any surgery, there's a risk of bleeding. Most of the time, your doctor will be able to control any bleeding or it will stop on its own. But bleeding may not happen until several hours, or even days, afterward. If you have bleeding in the days after surgery, in very rare cases, you may need another operation to treat it. It's common for a small amount of blood and other fluid to collect where the thyroid was removed. But sometimes a lot of blood can collect under the skin, and a hematoma can form. Hematomas are usually small and the body just absorbs them naturally. But in rare cases, a hematoma can be large and may block your airway. If this happens, you may have trouble breathing and you should call your doctor right away. Your doctor may need to drain the area, possibly with another operation. There is a risk of bad or allergic reactions to the anesthesia, medications, or materials that are used. While it's very rare, you can die from a serious reaction. Some people may have bad reactions to anesthesia. For example, they may feel sick to their stomach or throw up after their procedure. But an allergic reaction happens when your body tries to get rid of something it doesn't want. And it's your body's response that can be serious. Signs can include: Dizziness Swelling A rash Trouble breathing You should know that your healthcare team is trained and ready to respond to allergic reactions. But in rare cases, people can die. If you have ever had an allergic reaction, or know you are allergic to any drugs, foods, or materials (like latex), please let your doctors know. And let them know if you or anyone in your family has ever had a serious reaction to anesthesia. If surgery is done to treat thyroid cancer, there is a risk that this operation will NOT cure it. Even if the operation goes exactly as planned, there is a risk that cancer cells may still be in the body after surgery. Removing the thyroid gland often cures many kinds of thyroid cancer. But if cancer cells are still in the body after the operation, other treatments like radioactive iodine treatments may be done. In rare cases, chemotherapy may be needed after the operation. If surgery is done to treat thyroid cancer, there is a risk that cancer can return after the operation. If this happens, you'll need more thyroid cancer treatments. Your surgeon will do everything she can to remove all of the cancer. And even though it's uncommon, there is a risk that cancer will return (recur) sometime after surgery. If cancer returns, it can show up where the thyroid gland was, or in the lymph nodes. But very rarely, cancer can spread to other parts of the body like the lungs or bones. If cancer returns, you'll talk with your doctor about the best treatment plan for you. And this may include another operation. There is a risk of infection. In rare cases, more surgery may be needed to treat an infection. Although your surgeon will take great care to prevent it, you may get an infection in the area surgery as done, or in other parts of your body (like in your lungs or bladder). Signs of a wound infection include: Redness Swelling Fluid draining from the area surgery was done Pain that gets worse High fever or chills If you feel any of these things, please call your surgeon right away. Most of the time, antibiotics alone can get rid of an infection. But in some cases, you may need to be admitted to the hospital for surgery or other treatments. There is a risk of blood clots that, in rare cases, can be life threatening. Blood clots can form in your blood vessels during or after surgery. In rare cases, a blood clot can travel to the heart or lungs. This can be very dangerous and can even be life threatening. Signs of blood clots include: Sudden shortness of breath Severe chest pain Pain, redness, or swelling in one or both of your legs If you have any of these signs, call your surgeon or get emergency help right away. There is an extremely small risk of a stroke, heart attack, or death. Although the risk of a stroke, heart attack, or death is extremely small, these and other risks are possible during your surgery or recovery. Things like your age, the condition of your heart, being very overweight, and past illnesses and surgeries can make the operation more difficult. As a result, you could become seriously ill or die. Alternatives The decision to have a thyroidectomy is up to you. Thyroid cancerIf you've been diagnosed with thyroid cancer, a thyroidectomy is the only way to treat, or begin treating, your condition. Watchful waiting for harmless nodules or goiters For harmless nodules or goiters that don't cause problems, treatment isn't always done right away. This is called watchful waiting. Watchful waiting does NOT mean you or your doctor ignore your condition. Instead, physical exams or ultrasounds are done to keep a close eye on the nodule or goiter to see if it gets bigger or causes other problems. And if your condition becomes more serious later on, you and your doctor will decide if a thyroidectomy or other treatments are needed. Other treatments Other conditions like hyperthyroidism can often be treated with things like medication and radioactive iodine treatments.  You may have even tried them and they didn't work. But most likely, you've at least talked with your doctor about these treatments already and decided that surgery is right for you. This operation often works to treat, or begin treating, many thyroid conditions. And again, even though your body needs thyroid hormone to work well, there is medication to replace it. So even if your entire thyroid gland is removed, you can live a normal, healthy life. Health Information Forms After you print this summary, you can fill out the following forms. Keep a copy at home and take a copy to your next doctor's appointment. DISCLAIMER Emmi is an interactive, informational program offered by doctors to educate patients about risks, benefits, and potential outcomes associated with various medical treatments and surgical procedures. Your doctor has chosen to use Emmi to help you understand a health care procedure that he/she has recommended. To ensure that your doctor knows that you viewed this presentation, a record of your viewing will be sent to him or her as part of the informed consent process. By participating in this program, you are agreeing to allow Emmi to share the information you have provided to Emmi with your doctor. Emmi is provided for information and education purposes only. No doctor/patient relationship is established by your use of this program. Emmi provides no specific diagnosis or treatment for you. The information contained here is an educational supplement to your consultation with your doctor. While Emmi is intended to educate you about the procedure your doctor has recommended and the most common potential risks and complications of the procedure, it is not all-inclusive. There may be other complications, known and unknown, which result from the surgery. No guarantees or warranties are made regarding the surgery itself. Emmi is not intended to offer specific medical or surgical advice to anyone. It is also not a substitute for the informed consent process that your doctor will handle directly with you. Further, please be sure to discuss any questions or concerns you have regarding the information contained here, as well as the risks associated with refusing the treatment or procedure, directly with your doctor. By participating in this program, you are agreeing to allow Emmi to share the information you have provided to Emmi with your doctor. ©2011, Emmi Solutions, LLC. All rights reserved.