甲状腺疾病(英文版)课件

1、Thyroid DisordersWord ListThyroid 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Thyroidectomy 甲状腺切除术Thyroid crisis 甲状腺危象A tracheostomy

2、set 气管切开包Tetamy 手足抽搐Thyroid GlandIt is a part of the endocrine (内分泌) system, plays a major role in regulating the bodys metabolism.Section 1Anatomy/physiology of thyroidPlaceBlood supplyNerves supplyFunctionsAnatomy/physiology of thyroid Located in the lower neck anterior to the trachea. Two lateral

3、 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. Rich , from the superior and inferior thyroid artery.Artery: The arterial branches provide blood supply to other structures in the area.

4、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 The nerves supplying the thyroid originate from vagus (迷走神经）, innervate the epithelial cells （上皮细胞） of the follicles（滤泡） of

5、 the thyroid gland. One must be aware of the bilateral existence of a recurrent laryngeal nerve （喉返神经） during dissection. Produces, synthesizes , stores , and secretes Two Hormones Called Thyroxine (T4)Thyronine (T3)Regulates Metabolism so Your Cells Function ProperlyAffects Every Cell in the Body,

6、necessary for normal growth and developmentCommon disorder: A deficiency of iodine Other disorder : Autoimmune thyroid diseaseClassification: Hyperthyroidism(甲亢）, hypothyroidism（甲减）, tumours , cancer or goitre（甲状腺肿）. When the Thyroid Doesnt WorkHyperthyroidism Too Much Thyroid Hormone Metabolism Spe

7、eds UpHypothyroidism Too Little Thyroid Hormone Metabolism Slows DownHyperthyroidism(甲状腺功能亢进）Definition Hyperthyroidism is an imbalance of metabolism caused by overproduction of thyroid hormone.Cause: Increased secretion of thyroid hormone. Females : males = 4 : 1 , it tends to affect males more sev

8、erely . Incidence : 20 40 years old group . Clinical ManifestationGoiterExophthalmos (突眼征）Increased metabolic rateIncreased function of sympathetic nerve (交感神经）Cardiovascular alteration The thyroid can be palpated for asymmetry (不对称） and size. It may enlarge 3-4 times to its normal size. It is calle

9、d goitre. HyperthyroidismAs a result of increased thyroid hormone production, the client has an increased metabolic rate. Weight loss despite increased appetite , fatigue , poor tolerance to heat , and profuse perspiration, menstrual irregularities .Nervous, restlessness, irritability, difficulty co

10、ncentrating , emotional liability, mood swings, personality changes.Fine tremors of the fingers and tongue, shaky handwriting , clumsiness, trouble in climbing stairs, or dyspnea possibly at rest. The skin is warm and moist , characteristic salmon colour ( 鲜肉色） .The hair is fine and soft with premat

11、ure grey and increased hair loss . The nails appear fragile with distal nail separation from the nail bed . 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）. Diagnostic TestsTSH（促甲状腺激素）T3 , T4Radioactive

12、iodine uptake（131）Thyroid scanMensuration of basic metabolism rate (BMR)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 . Thyroid scan Scan are helpful in determining locat

13、ion , size, shape, and anatomic function of the thyroid gland.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) - 111GradeNormal: 10% Slightly abnormal: +20% +30% Moderately abno

14、rmal: +30% +60%Seriously abnormal: +60%TreatmentAntithyroid 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.Partial or complete thyroidectomy may be carried out a

15、s primary treatment .The type and extent of the surgery depend on the diagnosis, goal of surgery , and prognosis. Surgical IndicationsA very large goiter or a multinodular goiter with relatively low radioactive iodine uptakeMalignant thyroid nodule Psychologically or mentally incompetent patientsSur

16、geryA 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 treatment. SurgeryI

17、f 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.The neck is extended and a symmetrical, gently curved incision is made 1 to 2

18、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. Complications after surgeryDyspnea , asphyxiaInjury of laryngeal nerveSpasms Thyroid crisis（甲状腺危象）HaemorrhageHaematoma(血肿）formation

19、Tracheal collapse（气管塌陷）Tracheal mucous accumulationLaryngeal or local tissue edemaCauseComplications after surgery Respiratory distress and haemorrhage. Difficulty in respiration which is the occurs within after the surgery .most critical complication48 hoursManagement Surgical evacuation is require

20、d. 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.Preventive interventionsA tracheostomy set (气管切开包）is kept at the patients bedside at all times , and the surgeon is su

21、mmoned at the first indication of respiratory distress.Injury of laryngeal nerveAny voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神经）, which lies just behind the thyroid next to the trachea. Talk as little as possible. Can be cured spontaneously, or by

22、 physical therapy.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 twitching “tetany”laryngospasmManagementTemporaryLimit taking of meat , eggs which are high in phosphorus（磷）U

23、se of the sedative to control the pain Intravenous administration of calcium gluconate葡萄糖酸钙 Thyroid crisis (storm)Reason: insufficient preoperative preparation , a release of large amounts of thyroid hormone , rare Outcome: can lead to cardiac, hepatic or renal failure. Stressful factors: surgery ,

24、infection or trauma, pregnancy . Time of occurring : the first 12 hours postoperative. Clinical manifestation: Tachycardia ( 130 bmp)T 39, sometimes 41Exaggerated symptoms of hyperthyroidismDisturbances of a major system Gastrointestinal (diarrhea, abdominal pain) Neurologic (psychosis, somnolence,

25、coma) Cardiovascular (edema, chest pain, dyspnea, palpitations)Fatalness: The client may develop congestive heart failure and die .Preventions: The key is to do the preoperative preparation sufficiently , and perform the surgery until the BMR become normal.Medical ManagementThe physician must be inf

26、ormed immediately . Transfer the patient to the intensive care for closer monitoring Iodine is administered to decrease the output of thyroid hormone . Take KI solution 3ml orally , or put 10% iodine sodium 5ml into in 10% glucose, and give iv injection to the patient .200400mg Hydrocortisone氢化可的松 i

27、s prescribed to treat shock or adrenal insufficiency .The usage of sedative( luminal鲁米纳 Q6-8h)Reduce body temperature and heart rate and to prevent vascular collapse ( 37 ) . A large amount of glucose are needed .Oxygen therapy : Humidified oxygen is administered to improve tissue oxygenation and me

28、et the high metabolic demands Cardiac problems : arterial fibrillation, and congestive heart failure, sympatholytic agents may be administered, such as propranolol (心得安)Preoperative carePerfect preoperative careBaseline informationPharmacologic therapyMental supportNutritionInstruction Pharmacologic

29、 therapyIt is necessary for surgical treatment, but it can not act as a therapuetic medication.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 . 2 to 5 drops

30、 of potassium iodide solution(复方碘化钾) or Lugols iodine solution (卢戈氏液) are given 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 . Requirement : euthyroid Patient

31、s mood is steady , the sleep takes a favorable turn, gain weight , pulse 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NutritionSeveral well-balanced meals of small amount, even up to six meals a day. Highly seasoned foods and stimulants, such as coffee, tea , cola, and alc

32、ohol are discouraged. High-calorie, high-protein foods are encouraged. Preoperative teachingHow 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.Postoperative carePositionObservationOxygenNutritionMedicationHealth instructionObservation Cardiac and respiratory function