Thursday, December 16, 2010

Consent Information-Thyroidectomy (Total or Partial)



CONSENT INFORMATION - PATIENT COPY

THYROIDECTOMY (Total or Partial)

PLEASE READ THIS SHEET BEFORE YOU CONSENT TO YOUR SURGERY

This information sheet provides general information to a person having a Thyroid Surgery (Total or Partial). It does not provide advice to the individual. It is important that the content is discussed between you and your doctor who understands your level of fitness and your medical condition.


1. What is a Thyroidectomy?
A thyroidectomy is a surgical procedure for removing all or part of the thyroid gland.

2. When is it done?
A thyroidectomy may be done for patients who have a variety of thyroid conditions, including both cancerous and benign (non cancerous) thyroid nodule (lump) in your thyroid gland, large thyroid glands (goiters), and overactive thyroid glands.

3. Why do I need an operation?
The most common reason a patient is referred for Thyroid surgery is after an evaluation for a thyroid nodule which usually includes a Fine Needle Aspiration Cytology (FNAC) or biopsy. Surgery may be recommended for the following biopsy results: a) Diagnosed Cancer b) Possible cancer c) Benign (non malignant).
Surgery is also an option for Hyperthyroidism, large multinodular goiters and for any symptomatic goiter that has failed to be controlled by medication or radioactive iodine.

4. How do I prepare for the surgery?
Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find other people to help you with your day-to-day duties.
Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery. Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

5. The Operation:

This means removing my thyroid gland completely or nearly completely. Under a general anaesthetic, the surgeon makes a cut in along a skin crease in the lower part of the neck and lifts upper and lower flaps of skin and underlying tissues to give a good view of the thyroid gland. The lymph glands associated with the thyroid are inspected and any that are suspicious may be removed and sent for microscopic examination. The blood vessels to the thyroid are tied off and the gland gradually freed, while the surgeon looks for and protects two important structures nearby – the nerves that control the vocal cords (recurrent laryngeal nerves) and the parathyroid glands that help control the body’s calcium.

When the gland is free, it is sent for microscopic examination. Any bleeding points are sealed and a fine suction drain is often left in each side of the neck to remove any secretions. These will be removed after a day or two. The skin wound is closed.

How much of my thyroid glands needs to be removed?

Patients should discuss with the surgeon what operation on the thyroid is to be performed, such as lobectomy or total thyroidectomy, and the reasons why such a procedure is recommended. For patients with papillary or follicular thyroid cancer many, but not all, surgeons recommend total or near-total thyroidectomy when they believe that subsequent treatment such as that with radioactive iodine might be beneficial. For patients with large (>1.5 cm) primary tumors and for any medullary thyroid cancer, more extensive lymph node dissection is necessary to remove possibly involved lymph node metastases.

6. After the Operation:
* You may be in the hospital for about 2 or 3 days. You will have a scar on the front of your neck.
* You may have a small drain tube from the incision, which will be removed 1 or 2 days after surgery. This may cause your throat to be sore.
* If the surgeon removed all or a large part of the thyroid gland, you will have to take thyroid hormone medicine for the rest of your life.
* If you have a cancer, you may be advised to take a radioactive iodine medicine to destroy any remaining thyroid tissue and cancerous cells.
* Vigorous sports such as swimming and activities that involve lifting of heavy weights should be delayed for at least 3 weeks.
* Ask your health care provider what steps you should take and when you should come back for a checkup.

7. Will I be normal after having surgery?
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to doing anything that you could do prior to surgery. Many patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone. This is especially true if you had surgery for thyroid cancer. In addition, your doctor may recommend follow-up therapy with radioactive iodine if you have thyroid cancer prior to starting thyroid hormone therapy.

8. Benefits of Having the Surgery:
* Cosmetically, a large gland visible on the neck is removed and looks better.
* Prevents pressure effects on wind pipe and food pipe.
* If a cancer is detected, its further treatment can be advocated.
* Goiter associated with hyperthyroidism usually is benefited by surgery as medical treatment has been known to lead to high rates of relapse.

9. Risks of Not having the Surgery:
* Malignancy may remain undetected.
* Hemorrhage within the gland may cause acute respiratory obstruction.
* Growing goiter can produce pressure effects.
* Goiter may become hypersecrete thyroid hormone which per se will require surgery.

10. Alternative Treatments:

Please note that some alternative treatments may not be available or suitable to everyone

Alternatives to this procedure are:
* Choosing not to have treatment while recognizing the risk that a cancer may go untreated
* Choosing to have repeat exams over many months or years and having surgery if a nodule grows (there is some risk of spread if a nodule turns out to be malignant).
* You should ask your health care provider about these choices

11. After the surgery contact your doctor if:
* You develop a fever over 100°F (37.8°C).
* You have trouble breathing.
* You have tingling or muscle cramping in your face or cramping (muscle spasms) in your hands.

12. Specific Risks of this procedure:
While majority of patients have an uneventful surgery and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

(a) Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
(b) Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.fRe8
(c) Possible bleeding in the tissues of the neck which may result in swelling about the wound or a fluid discharge, or on rare occasions, pressure in the wind pipe which may cause breathing problems. This may require emergency surgery.
(d) Rarely an important nerve in the area of the back of the thyroid may be damaged which could result in a permanent hoarse voice, or difficulty with the higher pitch of the voice. It is very common to have a temporary hoarse voice for a few days as this operation is near the larynx. If both of these nerves were damaged, severe breathing difficulty may occur with the need for respiratory support. This may be permanent.
(e) Rarely a small gland behind the thyroid, called the parathyroid, may be damaged and this may result in tingling of the fingers and spasms of the hands and toes. This is usually a temporary problem but occasionally long term calcium supplements are necessary.
(f) After removal of part of the gland the function of the thyroid may decrease and you may need a test of thyroid function in the next few months and possible treatment for under activity of the thyroid. With total removal of the gland, life long medication is required.
(g) In some people healing of the wound may be abnormal and the wound can be thickened and red and may be painful.
(h) Other extremely rare risks/complications.
. Recovering from your operation

13. Consent Acknowledgement:
* The doctor has explained my medical condition and the proposed surgical procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes. The doctor has explained other relevant treatment options and their associated risks, the prognosis and the risks of not having the procedure.
* I have been given an Anaesthesia Informed Consent Form.
* I have been given a Patient Information Sheet about the procedure and its risks.
* I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options.
* My questions and concerns have been discussed and answered to my satisfaction.
* I understand that the procedure may include a blood / blood product transfusion.
* I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
* The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated as appropriate.
* It has been explained to me, that during the course of or subsequent to the Operation/Procedure, unforeseen conditions may be revealed or encountered which may necessitate urgent surgical or other procedures in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable.
On the basis of the above statements,

I REQUEST TO HAVE THE PROCEDURE.
Name of Patient/Substitute Decision Maker………………………………………
Relationship ………………………………
Signature…………………………………
Date………………………………………


Name of the Witness
Relationship/Designation………………
Signature…………………………………
Date………………………………………REFERENCES

INFORMED CONSENT: THYROIDECTOMY (SUB OR TOTAL)


Name________________________Age_______Yrs______Sex M______F_____

Registration No.___________Consultant____________________Bed No._____


A. INTERPRETER

An interpreter service is required Yes____No_______

If Yes, is a qualified interpreter present Yes_____No______

B. CONDITION AND PROCEDURE
The doctor has explained that I have the following condition:
(Doctor to document in patient’s own words)…………………………………………..
………………………………………………………………………………………………and
I have been advised to undergo the following treatment/ procedure………............
……………………………………………………………………………………………………..
See patient information sheet- "Thyroidectomy (Sub or Total)" - for more
Operation: Removal of part or all of the thyroid gland through a cut along the necklace line of the neck.

C.ANAESTHETIC
Please see your “Anesthesia Consent Form”. This gives you information of the General Risks of Surgery. If you have any concern, talk these over with your anaesthetist.

D.RISKS OF THIS PROCEDURE
While majority of patients have an uneventful surgery and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

(a) Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
(b) Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.fRe8
(c) Possible bleeding in the tissues of the neck which may result in swelling about the wound or a fluid discharge, or on rare occasions, pressure in the wind pipe which may cause breathing problems. This may require emergency surgery.
(d) Rarely an important nerve in the area of the back of the thyroid may be damaged which could result in a permanent hoarse voice, or difficulty with the higher pitch of the voice. It is very common to have a temporary hoarse voice for a few days as this operation is near the larynx. If both of these nerves were damaged, severe breathing difficulty may occur with the need for respiratory support. This may be permanent.
(e) Rarely a small gland behind the thyroid, called the parathyroid, may be damaged and this may result in tingling of the fingers and spasms of the hands and toes. This is usually a temporary problem but occasionally long term calcium supplements are necessary.
(f) After removal of part of the gland the function of the thyroid may decrease and you may need a test of thyroid function in the next few months and possible treatment for under activity of the thyroid. With total removal of the gland, life long medication is required.
(g) In some people healing of the wound may be abnormal and the wound can be thickened and red and may be painful.
(h) Other extremely rare risks/complications.

E.SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS
The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur.
The doctor also has explained relevant treatment options as well as the risks of not having the procedure.
(Doctor to document in medical record if necessary. Cross out if not applicable)

F.PATIENT CONSENT
I acknowledge that:
* The doctor has explained my medical condition and proposed procedure. I understand the risks of the procedure including the risks that are specific to me, and the likely outcomes.
* The doctor has explained other relevant treatment options and their associated risks. The doctor has also explained the risks of not having the procedure.
* I have been given the Anesthesia informed consent form.
* I have been given the Patient Information sheet related to the procedure and the risks.
* I was able to ask questions and raise concerns with the doctor the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
* I understand that the procedure may include a blood/blood product transfusion.
* I understand that a doctor other than the consultant surgeon may conduct the procedure I understand this could be a doctor undergoing further training.
* I understand that if organs or tissues are removed during the surgery that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
* The doctor explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
* It has been explained to me, that during the course of or subsequent to the Operation/Procedure, unforeseen conditions may be revealed or encountered which may necessitate urgent surgical or other procedures in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable.
* I understand that no guarantee has been made that the procedure will improve the condition and that the procedure may make my condition worse.
On the basis of the above statements,
I hereby authorize Dr……………………………………………………………………and those he may designate as associates or assistants to perform upon me the following medical treatment, surgical operation and / or diagnostic / therapeutic procedure………………..
……………………………………………………………………………………………………..
I REQUEST TO HAVE THE PROCEDURE

Name of Patient/Substitute Decision Maker…………………………………………….
Relationship ………………………………………………………………………………..
Signature…………………………………………………………………………………….
Date………………………………………………………………………………………….

Name of the Witness………………………………………………………………………
Relationship/Designation…………………………………………………………………
Signature……………………………………………………………………………………
Date………………………………………………………………………………………….
REFERENCES
G.INTERPRETER’S STATEMENT
I have given a translation in……………………………………………………………………
Name of interpreter……………………………………………………………………..
Signature……………………………………………………………………………………
Date………………………………………………………………………………………….

H. DOCTOR’S STATEMENTS
I have explained
* The patient ‘s condition
* Need for treatment
* The procedure and the risks
* Relevant treatment options and their risks
* Likely consequences if those risks occur
* The significant risks and problems specific to this patient
I have given the Patient/ Guardian an opportunity to:

* Ask questions about any of the above matters
* Raise any other concerns,
which I have answered as fully as possible.

I am of the opinion that the Patient/ Substitute Decision Maker understood the above information.

Name of doctor………………………………………………………………
Designation………………………………………………………………….
Signature…………………………………………………………………….
Date…………………………………………………………………………

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