甲状腺疾病英文版

ThyroidDisorders甲状腺疾病英文版第1页WordListThyroiddisorders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降钙素甲状腺疾病英文版第2页Recurrentlaryngealnerve喉返神经Hyperthyroidism甲亢Hypothyroidism甲减Goitre甲状腺肿Exophthalmos突眼症Tremor震颤TSH促甲状腺激素甲状腺疾病英文版第3页Thyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐甲状腺疾病英文版第4页ThyroidGlandItisapartoftheendocrine(内分泌)system,playsamajorroleinregulatingthebody'smetabolism.甲状腺疾病英文版第5页Section1Anatomy/physiologyofthyroid甲状腺疾病英文版第6页PlaceBloodsupplyNervessupplyFunctionsAnatomy/physiologyofthyroid甲状腺疾病英文版第7页Locatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峡部）Butterfly-shapedorgan5cmlong,3cmwide，30gTheparathyroidglands（甲状旁腺）

lyingonthedorsalside（后面）

ofthethyroidgland.甲状腺疾病英文版第8页Rich,fromthesuperiorandinferiorthyroidartery.Artery:Thearterialbranchesprovidebloodsupplytootherstructuresinthearea.Theinteriorthyroidarteryprovidesbranchestothepharynx,tracheaandesophagus.Vein:1)Thesuperiorthyroidvein2)Themiddlethyroidvein3)Theinferiorthyroidvein甲状腺疾病英文版第9页Thenervessupplyingthethyroidoriginatefromvagus(迷走神经）,innervatetheepithelialcells（上皮细胞）

ofthefollicles（滤泡）

ofthethyroidgland.Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神经）

duringdissection.甲状腺疾病英文版第10页Produces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopment甲状腺疾病英文版第11页Commondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲减）,tumours,cancerorgoitre（甲状腺肿）.甲状腺疾病英文版第12页WhentheThyroidDoesn’tWorkHyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUpHypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown甲状腺疾病英文版第13页Hyperthyroidism

(甲状腺功效亢进）甲状腺疾病英文版第14页DefinitionHyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.甲状腺疾病英文版第15页Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:20~40yearsoldgroup.甲状腺疾病英文版第16页ClinicalManifestationGoiterExophthalmos(突眼征）IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve

(交感神经）Cardiovascularalteration甲状腺疾病英文版第17页

Thethyroidcanbepalpatedforasymmetry(不对称）

andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.甲状腺疾病英文版第18页Hyperthyroidism

甲状腺疾病英文版第19页甲状腺疾病英文版第20页Asaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.甲状腺疾病英文版第21页Nervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.甲状腺疾病英文版第22页Theskiniswarmandmoist,characteristicsalmoncolour(鲜肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.甲状腺疾病英文版第23页

Tachycardia:

＞160bpmanddownto80bpmduringsleep.

Pulsepressureiswidened.Therecanbemuscularweaknessandatrophy(萎缩）,paralysis（瘫痪）.甲状腺疾病英文版第24页DiagnosticTestsTSH（促甲状腺激素）T3,T4Radioactiveiodineuptake（Ⅰ131）ThyroidscanMensurationofbasicmetabolismrate(BMR)甲状腺疾病英文版第25页TSH(Thyroid–StimulatingHormone)normalTSHreflectaeuthyroid(甲状腺机能正常）

state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.甲状腺疾病英文版第26页ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.甲状腺疾病英文版第27页Mensurationof

BasicMetabolismRate(BMR)

Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate

=(Pulserate+Pulsepressure)-111甲状腺疾病英文版第28页GradeNormal:±10%Slightlyabnormal:+20%~+30%Moderatelyabnormal:+30%~+60%Seriouslyabnormal:＞+60%甲状腺疾病英文版第29页TreatmentAntithyroiddrugs,radioactiveiodine,orthyroidectomy(甲状腺切除术）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.甲状腺疾病英文版第30页Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.甲状腺疾病英文版第31页SurgicalIndicationsAverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients甲状腺疾病英文版第32页SurgeryAportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.甲状腺疾病英文版第33页SurgeryIfapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.

甲状腺疾病英文版第34页Theneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（锁骨）.Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.甲状腺疾病英文版第35页Complicationsaftersurgery

Dyspnea,asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis（甲状腺危象）甲状腺疾病英文版第36页HaemorrhageHaematoma(血肿）formationTrachealcollapse（气管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema

Cause甲状腺疾病英文版第37页Complicationsaftersurgery

Respiratorydistressandhaemorrhage.Difficultyinrespiration

whichistheoccurswithinafterthesurgery.mostcriticalcomplication48hours甲状腺疾病英文版第38页ManagementSurgicalevacuationisrequired.

ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.

甲状腺疾病英文版第39页Preventiveinterventions

Atracheostomyset(气管切开包）iskeptatthepatient’sbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.

甲状腺疾病英文版第40页InjuryoflaryngealnerveAnyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神经）,whichliesjustbehindthethyroidnexttothetrachea.

Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.甲状腺疾病英文版第41页SpasmTheparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”laryngospasm甲状腺疾病英文版第42页ManagementTemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙

甲状腺疾病英文版第43页Thyroidcrisis(storm)Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rareOutcome:canleadtocardiac,hepaticorrenalfailure.Stressfulfactors:surgery,infectionortrauma,pregnancy.

甲状腺疾病英文版第44页Timeofoccurring:thefirst12hourspostoperative.Clinicalmanifestation:

Tachycardia(＞130bmp)T＞39℃,sometimes＞41℃ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem

甲状腺疾病英文版第45页

Gastrointestinal

(diarrhea,abdominalpain)

Neurologic(psychosis,somnolence,coma)Cardiovascular

(edema,chestpain,dyspnea,palpitations)

甲状腺疾病英文版第46页Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.甲状腺疾病英文版第47页MedicalManagementThephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.

甲状腺疾病英文版第48页200~400mgHydrocortisone氢化可松

isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal鲁米纳Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37℃).

Alargeamountofglucoseareneeded.甲状腺疾病英文版第49页Oxygentherapy:

Humidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemands

Cardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安)甲状腺疾病英文版第50页PreoperativecarePerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction甲状腺疾病英文版第51页Pharmacologictherapy

Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.甲状腺疾病英文版第52页

2to5dropsofpotassiumiodidesolution(复方碘化钾)orLugol’siodinesolution

(卢戈氏液)aregiveninconjunctionwithpropylthiouracil

(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid..甲状腺疾病英文版第53页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、代谢恢复甲状腺疾病英文版第54页NutritionSeveralwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.

甲状腺疾病英文版第55页PreoperativeteachingHowtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.

甲状腺疾病英文版第56页PostoperativecarePositionObservationOxygenNutritionMedicationHealthinstruction甲状腺疾