Thyroid Lobectomy and Treatment of Acute Thyroidism.

Kai Tiaki : the journal of the nurses of New Zealand, Volume VI, Issue 2, 1 April 1913, Page 66

Thyroid Lobectomy and Treatment of Acute Thyroidism.

Patient, a girl aged 20, of a nervous, excitable temperament, suffering from exopthalmic goitre and its effects, e.g. dyspnoea, disordered heart, slight exophthalmos and tremor. Goitre was not very large externally, but pressing on trachea, especially when patient lies down, causing dyspnoea. There was breath lessness on least exertion, and patient could feel heart thumping. The heart was very much dilated, and beating quickly and forcibly — 120 per minute.

Operation : Thyroid lobectomy performed. Right lobe of gland, and isthmus excised. Anaesthetic, open ether. Collar incision made m front of trachea. Anterior jugular vein ligatured. Gland dislocated out of its bed and thyroid vessels secured and ligatured. There was a great deal of hemorrhage, the wound was irrigated with

saline and drainage tube inserted. Digit a - lone mx. given hypodemically whilst on table. Patient stood operation well.

Treatment.

First Day. — Warded m a quiet room. The head of bed raised on blocks, and continuous saline started. Very little retained, and it had to be discontinued, as it acted as a purgative. Patient perspiring freely. The pulse became rapid and irregular. Head of bed was lowered and pulse improved. Ice bag discontinued. Dressing changed twice during evening. Very little (serous) discharge. Ice bags placed over heart and on either side of neck. Applied to neck to retard healing, and not allow secretion to escape ; prevents thyroidism from becoming marked. Drainage tube for same purpose. Plenty of water was given to drink to flush out system and clear toxins from blood.

Continuous saline started again, but had to be discontinued as none was retained. Patient had pain on swallowing. Symptoms of acute thyroidism developing. Trembling started during night and was very restless. Face flushed, respirations shallow: Trembling and restlessness increased towards morning. Pulse 160 per minute.

Second Day. — Dressing changed. Tube found blocked ; the wound was widened with probe. There was a little blood discharge. Tube was sterilised and replaced. Patient felt much easier. Dressing was changed again at mid-day, tube discontinued and wound packed with gauze. No bandage was applied, the throat was sore. Patient became cyanosed at 4 p.m., and her pulse was rapid and weak. The throat was tight and sore, causing extreme dyspnoea. Saline 15 ounces was given subcutaneously and digitaline live mimims injected hypodermically. The patient became easier and cyanosis lessened. The pulse at 6 p.m. was 160 — at 8 p.m. 180, and at 9 p.m. 120 per minute. Temperature 102°. Digitaline 5 mimims was ordered to be given 4-hourly to slow and strengthen the heart's action. The patient was kept on her right side to allow free drainage from the wound and free action of heart. Her face was very flushed. Half a grain of morphia was injected at 9 p.m. The foot of bed was raised on blocks. The pulse became rapid at times, sometimes 170 per minute. There was no dyspnoea. At 11.30 p.m. morphia one-sixth of a grain and digitalone 10 mimims was injected, atropine one-hundredth of a grainat 12 o'clock, midnight. There was no pain m throat, no ooz-

ing from wound ; the patient could swallow f 1 uids easily and had a good night. Temperature went down to 101°, pulse 120, respiration, 20.

Third Day. — The pulse was ol good tension and regular. The dressing was done, theie was no discharge, and packing was discontinued. Digitalone, ten mimims, was ordered and given eight-hourly. The patient was perspiring freely. Atropine, one-twentieth of a grain, was to be injected if perspiration increased. The temperature was 100°, pulse 96, respiration 20. The patient was very peevish, one ice bag was discontinued.

Fourth Day. — Dressing was done and there was little discharge. The pulse was good. Digitalone was discontinued and all ice-bags. Plenty of drinks were given and taken well. The temperature was 101°, pulse 96, respiration 24. The patient slept all night.

Fifth Day. — The dressing was done, sutures cut and dry dressing applied. Temperature 101.2°, pulse good 104, respiration 24. Patient feeling very well.

Sixth Day. — The dressing was done and deep sutures removed, very little discharge, no pain. Drinks and jelly were taken well. Temperature 100.6°, pulse 102. respiration 20. The pulse was of good tension and regular.

The bowels moved regularly (naturally). Patient was put gradually on to light milk diet. The wound healed aseptically, all symptoms of thyroidism disappeared grad-

ually. Nurse S.