甲状腺疾病(英文版).ppt

ThyroidDisorders 主讲人 WordList Thyroiddisorders甲状腺病症Isthmus峡部Thyroxine甲状腺素Triiodothyronine三碘甲状腺氨酸Parathyroidglands甲状旁腺Calcitonin降钙素 Recurrentlaryngealnerve喉返神经Hyperthyroidism甲亢Hypothyroidism甲减Goitre甲状腺肿Exophthalmos突眼症Tremor震颤TSH促甲状腺激素 Thyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐 ThyroidGland Itisapartoftheendocrine 内分泌 system playsamajorroleinregulatingthebody smetabolism Section1 Anatomy physiologyofthyroid PlaceBloodsupplyNervessupplyFunctions Anatomy physiologyofthyroid Locatedinthelowerneckanteriortothetrachea Twolaterallobesconnectedbyanisthmus 峡部 Butterfly shapedorgan5cmlong 3cmwide 30gTheparathyroidglands 甲状旁腺 lyingonthedorsalside 背面 ofthethyroidgland Rich fromthesuperiorandinferiorthyroidartery Artery Thearterialbranchesprovidebloodsupplytootherstructuresinthearea Theinteriorthyroidarteryprovidesbranchestothepharynx tracheaandesophagus Vein 1 Thesuperiorthyroidvein2 Themiddlethyroidvein3 Theinferiorthyroidvein Thenervessupplyingthethyroidoriginatefromvagus 迷走神经 innervatetheepithelialcells 上皮细胞 ofthefollicles 滤泡 ofthethyroidgland Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve 喉返神经 duringdissection Produces synthesizes stores andsecretesTwoHormonesCalledThyroxine T4 Thyronine T3 RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody necessaryfornormalgrowthanddevelopment Commondisorder AdeficiencyofiodineOtherdisorder AutoimmunethyroiddiseaseClassification Hyperthyroidism 甲亢 hypothyroidism 甲减 tumours cancerorgoitre 甲状腺肿 WhentheThyroidDoesn tWork HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown Hyperthyroidism 甲状腺功能亢进 Definition Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone Cause Increasedsecretionofthyroidhormone Females males 4 1 ittendstoaffectmalesmoreseverely Incidence 20 40yearsoldgroup ClinicalManifestation GoiterExophthalmos 突眼征 IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve 交感神经 Cardiovascularalteration Thethyroidcanbepalpatedforasymmetry 不对称 andsize Itmayenlarge3 4timestoitsnormalsize Itiscalledgoitre Hyperthyroidism Asaresultofincreasedthyroidhormoneproduction theclienthasanincreasedmetabolicrate Weightlossdespiteincreasedappetite fatigue poortolerancetoheat andprofuseperspiration menstrualirregularities Nervous restlessness irritability difficultyconcentrating emotionalliability moodswings personalitychanges Finetremorsofthefingersandtongue shakyhandwriting clumsiness troubleinclimbingstairs ordyspneapossiblyatrest Theskiniswarmandmoist characteristicsalmoncolour 鲜肉色 Thehairisfineandsoftwithprematuregreyandincreasedhairloss Thenailsappearfragilewithdistalnailseparationfromthenailbed Tachycardia 160bpmanddownto80bpmduringsleep Pulsepressureiswidened Therecanbemuscularweaknessandatrophy 萎缩 paralysis 瘫痪 DiagnosticTests TSH 促甲状腺激素 T3 T4Radioactiveiodineuptake 131 ThyroidscanMensurationofbasicmetabolismrate BMR TSH Thyroid StimulatingHormone normalTSHreflectaeuthyroid 甲状腺机能正常的 state Hyperthyroidism TSHisloworabsent Inmildformsofhyperthyroidism slightlyabnormal ThyroidscanScanarehelpfulindetermininglocation size shape andanatomicfunctionofthethyroidgland MensurationofBasicMetabolismRate BMR Conditions Earlyinthemorning emptystomach atthetimeofrestBasicMetabolismRate Pulserate Pulsepressure 111 Grade Normal 10 Slightlyabnormal 20 30 Moderatelyabnormal 30 60 Seriouslyabnormal 60 Treatment Antithyroiddrugs radioactiveiodine orthyroidectomy 甲状腺切除术 Individualizedanddependsontheageandgeneralstateofhealth thesizeofthegoiterandtheabilitytoobtainfollow upcare Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment Thetypeandextentofthesurgerydependonthediagnosis goalofsurgery andprognosis SurgicalIndications AverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients Surgery Aportionofthethyroidglandisremoved butatotalthyroidectomymaybeperformed expensive risks Indicationsforsubtotalthyroidectomy themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment Surgery Ifapartialthyroidectomyisdone theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones Ifacompletethyroidectomyisdone theclientwillrequirethyroidhormonereplacementforalifetime Theneckisextendedandasymmetrical gentlycurvedincisionismade1to2cmabovetheclavicle 锁骨 Closureofthewoundisaccomplishedbythestrapmusclesinthemidline Asmallsuctioncatheterisusuallyinsertedthroughastabwound Complicationsaftersurgery Dyspnea asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis 甲状腺危象 HaemorrhageHaematoma 血肿 formationTrachealcollapse 气管塌陷 TrachealmucousaccumulationLaryngealorlocaltissueedema Cause Complicationsaftersurgery Respiratorydistressandhaemorrhage Difficultyinrespirationwhichistheoccurswithinafterthesurgery mostcriticalcomplication 48hours Management Surgicalevacuationisrequired ThefirstaidbythebedA cutoffthesutureB openedthewoundwideC removedthehematomaThetracheaiscut applyoxygenSendtotheoperationroomforfurthertreatment Preventiveinterventions Atracheostomyset 气管切开包 iskeptatthepatient sbedsideatalltimes andthesurgeonissummonedatthefirstindicationofrespiratorydistress Injuryoflaryngealnerve Anyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve 喉返神经 whichliesjustbehindthethyroidnexttothetrachea Talkaslittleaspossible Canbecuredspontaneously orbyphysicaltherapy Spasm Theparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching tetany laryngospasm Management TemporaryLimittakingofmeat eggswhicharehighinphosphorus 磷 UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙 Thyroidcrisis storm Reason insufficientpreoperativepreparation areleaseoflargeamountsofthyroidhormone rareOutcome canleadtocardiac hepaticorrenalfailure Stressfulfactors surgery infectionortrauma pregnancy Timeofoccurring thefirst12hourspostoperative Clinicalmanifestation Tachycardia 130bmp T 39 sometimes 41 ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem Gastrointestinal diarrhea abdominalpain Neurologic psychosis somnolence coma Cardiovascular edema chestpain dyspnea palpitations Fatalness Theclientmaydevelopcongestiveheartfailureanddie Preventions Thekeyistodothepreoperativepreparationsufficiently andperformthesurgeryuntiltheBMRbecomenormal MedicalManagement Thephysicianmustbeinformedimmediately TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone TakeKIsolution3mlorally orput10 iodinesodium5mlintoin10 glucose andgiveivinjectiontothepatient 200 400mgHydrocortisone氢化可的松isprescribedtotreatshockoradrenalinsufficiency Theusageofsedative luminal鲁米纳Q6 8h Reducebodytemperatureandheartrateandtopreventvascularcollapse 37 Alargeamountofglucoseareneeded Oxygentherapy HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems arterialfibrillation andcongestiveheartfailure sympatholyticagentsmaybeadministered suchaspropranolol 心得安 Preoperativecare PerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction Pharmacologictherapy Itisnecessaryforsurgicaltreatment butitcannotactasatherapueticmedication Encouragesthepatienttotakethemedicationsasprescribed Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding 2to5dropsofpotassiumiodidesolution 复方碘化钾 orLugol siodinesolution 卢戈氏液 aregiveninconjunctionwithpropylthiouracil 丙基硫尿嘧啶 todecreasethefriabilityandvascularityofthethyroid itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid Requirement euthyroidPatient smoodissteady thesleeptakesafavorableturn gainweight pulserate 90times min BasicMetabolismRate 20 情绪稳定 睡眠正常 体重增加 心跳正常 代谢恢复 Nutrition Severalwell balancedmealsofsmallamount evenuptosixmealsaday Highlyseasonedfoodsandstimulants suchascoffee tea cola andalcoholarediscouraged High calorie high proteinfoodsareencouraged Preoperativeteaching Howtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision Eyecareandprotectionmaybecomenecessary correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea Postoperativecare PositionObservationOxygenNutritionMedicationHealthinstruction Observation Cardiacandre