甲状腺疾病(英文版)（医药参考）

1、,Thyroid Disorders,1,医药参考,Word List,Thyroid disorders 甲状腺病症 Isthmus 峡部 Thyroxine 甲状腺素 Triiodothyronine 三碘甲状腺氨酸 Parathyroid glands 甲状旁腺 Calcitonin 降钙素,2,医药参考,Recurrent laryngeal nerve 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,3,医药参考,Thyroidectomy 甲状腺切

2、除术 Thyroid crisis 甲状腺危象 A tracheostomy set 气管切开包 Tetamy 手足抽搐,4,医药参考,Thyroid Gland,It is a part of the endocrine (内分泌) system, plays a major role in regulating the bodys metabolism.,5,医药参考,Section 1,Anatomy/physiology of thyroid,6,医药参考,Place Blood supply Nerves supply Functions,Anatomy/physiology of

3、thyroid,7,医药参考,Located in the lower neck anterior to the trachea. Two lateral lobes connected by an isthmus（峡部） Butterfly- shaped organ 5cm long , 3cm wide ，30g The parathyroid glands（甲状旁腺） lying on the dorsal side（背面） of the thyroid gland.,8,医药参考,Rich , from the superior and inferior thyroid artery

4、. Artery: The arterial branches provide blood supply to other structures in the area. The interior thyroid artery provides branches to the pharynx, trachea and esophagus . Vein: 1) The superior thyroid vein 2) The middle thyroid vein 3) The inferior thyroid vein,9,医药参考,The nerves supplying the thyro

5、id originate from vagus (迷走神经）, innervate the epithelial cells （上皮细胞） of the follicles（滤泡） of the thyroid gland. One must be aware of the bilateral existence of a recurrent laryngeal nerve （喉返神经） during dissection.,10,医药参考,Produces, synthesizes , stores , and secretes Two Hormones Called Thyroxine (

6、T4) Thyronine (T3) Regulates Metabolism so Your Cells Function Properly Affects Every Cell in the Body, necessary for normal growth and development,11,医药参考,Common disorder: A deficiency of iodine Other disorder : Autoimmune thyroid disease Classification: Hyperthyroidism(甲亢）, hypothyroidism（甲减）, tum

7、ours , cancer or goitre（甲状腺肿）.,12,医药参考,When the Thyroid Doesnt Work,Hyperthyroidism Too Much Thyroid Hormone Metabolism Speeds Up,Hypothyroidism Too Little Thyroid Hormone Metabolism Slows Down,13,医药参考,Hyperthyroidism(甲状腺功能亢进）,14,医药参考,Definition,Hyperthyroidism is an imbalance of metabolism caused b

8、y overproduction of thyroid hormone.,15,医药参考,Cause: Increased secretion of thyroid hormone. Females : males = 4 : 1 , it tends to affect males more severely . Incidence : 20 40 years old group .,16,医药参考,Clinical Manifestation,Goiter Exophthalmos (突眼征） Increased metabolic rate Increased function of s

9、ympathetic nerve (交感神经） Cardiovascular alteration,17,医药参考,The thyroid can be palpated for asymmetry (不对称） and size. It may enlarge 3-4 times to its normal size. It is called goitre.,18,医药参考,Hyperthyroidism,19,医药参考,20,医药参考,As a result of increased thyroid hormone production, the client has an increas

10、ed metabolic rate. Weight loss despite increased appetite , fatigue , poor tolerance to heat , and profuse perspiration, menstrual irregularities .,21,医药参考,Nervous, restlessness, irritability, difficulty concentrating , emotional liability, mood swings, personality changes. Fine tremors of the finge

11、rs and tongue, shaky handwriting , clumsiness, trouble in climbing stairs, or dyspnea possibly at rest.,22,医药参考,The skin is warm and moist , characteristic salmon colour ( 鲜肉色） . The hair is fine and soft with premature grey and increased hair loss . The nails appear fragile with distal nail separat

12、ion from the nail bed .,23,医药参考,Tachycardia : 160 bpm and down to 80 bpm during sleep. Pulse pressure is widened. There can be muscular weakness and atrophy (萎缩）, paralysis（瘫痪）.,24,医药参考,Diagnostic Tests,TSH（促甲状腺激素） T3 , T4 Radioactive iodine uptake（131） Thyroid scan Mensuration of basic metabolism r

13、ate (BMR),25,医药参考,TSH (ThyroidStimulating Hormone) normal TSH reflect a euthyroid (甲状腺机能正常的） state. Hyperthyroidism : TSH is low or absent . In mild forms of hyperthyroidism : slightly abnormal .,26,医药参考,Thyroid scan Scan are helpful in determining location , size, shape, and anatomic function of th

14、e thyroid gland.,27,医药参考,Mensuration of Basic Metabolism Rate ( BMR ),Conditions : Early in the morning , empty stomach , at the time of rest Basic Metabolism Rate = ( Pulse rate + Pulse pressure) - 111,28,医药参考,Grade,Normal: 10% Slightly abnormal: +20% +30% Moderately abnormal: +30% +60% Seriously a

15、bnormal: +60%,29,医药参考,Treatment,Antithyroid drugs , radioactive iodine, or thyroidectomy (甲状腺切除术）. Individualized and depends on the age and general state of health ，the size of the goiter and the ability to obtain follow-up care.,30,医药参考,Partial or complete thyroidectomy may be carried out as prima

16、ry treatment . The type and extent of the surgery depend on the diagnosis, goal of surgery , and prognosis.,31,医药参考,Surgical Indications,A very large goiter or a multinodular goiter with relatively low radioactive iodine uptake Malignant thyroid nodule Psychologically or mentally incompetent patient

17、s,32,医药参考,Surgery,A portion of the thyroid gland is removed, but a total thyroidectomy may be performed (expensive, risks). Indications for subtotal thyroidectomy : the main advantages are rapid control of the disease and a lower incidence of hypothyroidism than can be achieved with radioiodine trea

18、tment.,33,医药参考,Surgery,If a partial thyroidectomy is done , the remaining thyroid tissue should provide adequate amounts of thyroid hormones. If a complete thyroidectomy is done, the client will require thyroid hormone replacement for a lifetime.,34,医药参考,The neck is extended and a symmetrical, gentl

19、y curved incision is made 1 to 2 cm above the clavicle（锁骨）.,Closure of the wound is accomplished by the strap muscles in the midline. A small suction catheter is usually inserted through a stab wound.,35,医药参考,Complications after surgery,Dyspnea , asphyxia Injury of laryngeal nerve Spasms Thyroid cri

20、sis（甲状腺危象）,36,医药参考,Haemorrhage Haematoma(血肿）formation Tracheal collapse（气管塌陷） Tracheal mucous accumulation Laryngeal or local tissue edema,Cause,37,医药参考,Complications after surgery,Respiratory distress and haemorrhage. Difficulty in respiration which is the occurs within after the surgery .,most cri

21、tical complication,48 hours,38,医药参考,Management,Surgical evacuation is required. The first aid by the bed A. cut off the suture B. opened the wound wide C. removed the hematoma The trachea is cut , apply oxygen Send to the operation room for further treatment.,39,医药参考,Preventive interventions,A trach

22、eostomy set (气管切开包）is kept at the patients bedside at all times , and the surgeon is summoned at the first indication of respiratory distress.,40,医药参考,Injury of laryngeal nerve,Any voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神经）, which lies just behi

23、nd the thyroid next to the trachea. Talk as little as possible. Can be cured spontaneously, or by physical therapy.,41,医药参考,Spasm,The parathyroid glands may be injured or removed disturbance of the calcium metabolism of the body blood calcium level falls spasms of the hands and feet and muscular twi

24、tching “tetany”,laryngospasm,42,医药参考,Management,Temporary Limit taking of meat , eggs which are high in phosphorus（磷） Use of the sedative to control the pain Intravenous administration of calcium gluconate葡萄糖酸钙,43,医药参考,Thyroid crisis (storm),Reason: insufficient preoperative preparation , a release

25、of large amounts of thyroid hormone , rare Outcome: can lead to cardiac, hepatic or renal failure. Stressful factors: surgery , infection or trauma, pregnancy .,44,医药参考,Time of occurring : the first 12 hours postoperative. Clinical manifestation: Tachycardia ( 130 bmp) T 39, sometimes 41 Exaggerated

26、 symptoms of hyperthyroidism Disturbances of a major system,45,医药参考,Gastrointestinal (diarrhea, abdominal pain) Neurologic (psychosis, somnolence, coma) Cardiovascular (edema, chest pain, dyspnea, palpitations),46,医药参考,Fatalness: The client may develop congestive heart failure and die . Preventions:

27、 The key is to do the preoperative preparation sufficiently , and perform the surgery until the BMR become normal.,47,医药参考,Medical Management,The physician must be informed immediately . Transfer the patient to the intensive care for closer monitoring Iodine is administered to decrease the output of

28、 thyroid hormone . Take KI solution 3ml orally , or put 10% iodine sodium 5ml into in 10% glucose, and give iv injection to the patient .,48,医药参考,200400mg Hydrocortisone氢化可的松 is prescribed to treat shock or adrenal insufficiency . The usage of sedative( luminal鲁米纳 Q6-8h) Reduce body temperature and

29、heart rate and to prevent vascular collapse ( 37 ) . A large amount of glucose are needed .,49,医药参考,Oxygen therapy : Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demands Cardiac problems : arterial fibrillation, and congestive heart failure, sympatholyt

30、ic agents may be administered, such as propranolol (心得安),50,医药参考,Preoperative care,Perfect preoperative care Baseline information Pharmacologic therapy Mental support Nutrition Instruction,51,医药参考,Pharmacologic therapy,It is necessary for surgical treatment, but it can not act as a therapuetic medic

31、ation. Encourages the patient to take the medications as prescribed . Iodine preparations may have been prescribed 10 to 14 days before surgery to decrease thyroid vascularity and decrease bleeding .,52,医药参考,2 to 5 drops of potassium iodide solution(复方碘化钾) or Lugols iodine solution (卢戈氏液) are given

32、in conjunction with propylthiouracil (丙基硫尿嘧啶) to decrease the friability and vascularity of the thyroid, it should be applied until the time of operation and the patient became euthyroid . .,53,医药参考,Requirement : euthyroid Patients mood is steady , the sleep takes a favorable turn, gain weight , pul

33、se rate 90 times /min , Basic Metabolism Rate +20%. 情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复,54,医药参考,Nutrition,Several well-balanced meals of small amount, even up to six meals a day. Highly seasoned foods and stimulants, such as coffee, tea , cola, and alcohol are discouraged. High-calorie, high-protein foods are

34、encouraged.,55,医药参考,Preoperative teaching,How to support the neck with the hands after surgery to prevent stress on the incision. Eye care and protection may become necessary , correct instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed cornea.,56,医药参考,Postoperative care,Position Observation Oxygen Nutrition Medication Health instruction,57,医药参考,Observation,Cardiac and respiratory