CLINICAL PRACTICE TIP: POST-THYROIDECTOMY VILLIANS

Four years ago I underwent a total thyroidectomy. I can remember waking up in the recovery room and being transported to my room. The first thing I said to my husband when I got to my room was this: “Look on my night stand and make sure you see a trach kit and a box of calcium gluconate.” Even though I was half out of it, I wanted to make sure that the nurses were prepared to handle the two most common complications of a thryoidectomy – hemorrhage and hypocalcemia.

I won’t spend time talking about hemorrhage but basically, if your patient hemorrhages, you may need to trach him/her emergently.

The other complication (or villain) is hypocalcemia. To understand how this occurs, you need to understand the role calcium plays in the body (beyond bone strength).

Calcium

Calcium acts as a sedative at the neuromuscular junction. So, the more calcium you have, the more sedated your cells are. The lower your calcium levels gets, the more excited or stimulated your cells become.

The Role of the Parathyroid Glands

It is the parathyroid glands that manage the balance of calcium in the bloodstream. When someone (like me) undergoes a thyroidectomy, sometimes the parathyroid glands either get inadvertently removed or just get ticked off and decide to stop working for a bit. When this happens, calcium levels can plummet!  

Hypocalcemia

When calcium levels get super low, we worry about the patients having spasms. Evidence of hypocalcemia presents as Chvostek’s sign (tap the cheek and watch the facial nerve twitch) or Trousseau’s sign (pump up a blood pressure cuff and watch the patient’s arm spasm – which hurts!).

But, what we REALLY worry about in our thyroidectomy patients is that they will have a laryngospasm. If this happens, they will lose their airway. The treatment? Immediate administration of Calcium Gluconate. You may need to repeat this until the parathyroid glands decide to start working or the patients gets placed on calcium replacement therapy.

Bottom line: post thyroidectomy patient? Always, always make sure you are prepared with Calcium Gluconate AND trach kit (just in case).

I’m happy to report that my husband confirmed that yes…there was a lovely box of Calcium Gluconate and trach kit. I’m even happier to report that they remained unopened.

I hope these tips help you take great care of your post-thyroidectomy patients.

Thanks for becoming a nurse. Take care and stay connected!

Renee

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