甲状腺疾病(英文版)

,ThyroidDisorders,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,playsamajorroleinregulatingthebodysmetabolism.,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）.,WhentheThyroidDoesntWork,HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp,HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown,Hyperthyroidism(甲状腺功能亢进）,Definition,Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.,Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:2040yearsoldgroup.,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(ThyroidStimulatingHormone)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）iskeptatthepatientsbedsideatalltimes,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)T39,sometimes41ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem,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.,200400mgHydrocortisone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)orLugolsiodinesolution(卢戈氏液)aregiveninconjunctionwithpropylthiouracil(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid.,Requirement:euthyroidPatientsmoodissteady,thesleeptakesafavorableturn,gainweight,pulserate90times/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,Cardiacandr