The nurse should carefully monitor the airway, respiratory rate, breath sounds, and pulse oximetry. Palpation to assess for crepitus should also be done. A positive finding is an indication of the presence of subcutaneous emphysema. Signs and symptoms of impending respiratory obstruction such as tracheal deviation, stridor, air hunger, or falling oxygen saturations should be reported immediately to the anesthesia provider and surgeon. In some situations, immediate reintubation or tracheostomy may be necessary; therefore, the associated reintubation or tracheostomy equipment should be readily available for use. Hypertension and transient elevations of blood pressure should be avoided to decrease stress on suture lines and to avoid hematoma and hemorrhage. Prevention and management of heavy coughing, nausea, vomiting, or dry retching are essential.

Pain may be minimal after thyroidectomy and parathyroidectomy when performed on an outpatient basis. Postoperative analgesia requirements are greater in the open procedure population. Small doses of an opioid may be needed in the first 24 hours for patients admitted to a facility. Severe pain is an abnormal finding that can indicate unexpected bleeding or nerve damage and is a risk factor for unwanted hypertension.

Postoperative dressings are typically small as minimally invasive procedures are becoming the most commonly used surgical approach. Postoperative drainage is minimal and should not visibly soak through the dressing. Surgical drains are generally not required, although some disagreement persists regarding their use. Questions exist regarding whether the presence of a drain causes increased pain, scarring, cost, length of stay, and a drain’s limited ability to identify and prevent hematoma.^4,5 Drains may be indicated in the presence of greater intraoperative blood loss, an extensive procedure, or when a large space is left after removal of a tumor or goiter.

As with any surgical patient, intake and output monitoring is important for the evaluation of cardiovascular stability. Because many thyroid surgeries are performed on an outpatient basis, it is important to ensure that the patient is capable of tolerating oral fluids before discharge. Routine phonation and swallowing evaluations serve to rule out laryngeal nerve damage, which could precipitate aspiration.

As knowledge of thyroid and parathyroid function and interventional surgical techniques have improved, postoperative complication rates have decreased and now reportedly occur in less than 1% of patients. Complications are largely attributed to surgeon skill level, type and invasiveness of tumor, anatomic visualization during the procedure, and the patient’s preoperative thyroid state. The increase in ambulatory surgical intervention in this population requires vigilance for typical discharge concerns such as nausea and vomiting, which may disrupt suture lines and raise blood pressure. The signs and symptoms of bleeding and airway compromise should be included in the discharge instructions for ambulatory cases.