1、,Thyroid Disorders,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,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
2、象A tracheostomy set 气管切开包Tetamy 手足抽搐,Thyroid Gland,It is a part of the endocrine (内分泌) system, plays a major role in regulating the bodys metabolism.,Section 1,Anatomy/physiology of thyroid,Place Blood supply Nerves supply Functions,Anatomy/physiology of thyroid,Located in the lower neck anterior to
3、 the trachea. Two lateral lobes connected by an isthmus（峡部） Butterfly- shaped organ5cm long , 3cm wide ，30gThe 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
4、 structures in the area. The interior thyroid artery provides branches to the pharynx, trachea and esophagus . Vein:1) The superior thyroid vein2) 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）
5、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.,Produces, synthesizes , stores , and secretes Two Hormones Called Thyroxine (T4) Thyronine (T3)Regulates Metabolism so Your Cells Function ProperlyAffects
6、Every Cell in the Body, necessary for normal growth and development,Common disorder: A deficiency of iodine Other disorder : Autoimmune thyroid disease Classification: Hyperthyroidism(甲亢）, hypothyroidism（甲减）, tumours , cancer or goitre（甲状腺肿）.,When the Thyroid Doesnt Work,HyperthyroidismToo Much Thyr
7、oid HormoneMetabolism Speeds Up,HypothyroidismToo Little Thyroid HormoneMetabolism Slows Down,Hyperthyroidism (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 te
8、nds to affect males more severely . Incidence : 20 40 years old group .,Clinical Manifestation,Goiter Exophthalmos (突眼征） Increased metabolic rate Increased 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 time
9、s to its normalsize. It is called goitre.,Hyperthyroidism,As 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, restles
10、sness, irritability, difficulty concentrating , 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） . T
11、he hair is fine and soft with premature 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
12、 Tests,TSH（促甲状腺激素） T3 , T4 Radioactive iodine uptake（131） Thyroid scan Mensuration 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 s
13、canScan are helpful in determining location , 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) - 111,Grade,Normal: 10% S
14、lightly abnormal: +20% +30% Moderately abnormal: +30% +60% Seriously abnormal: +60%,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.,Partial
15、 or complete thyroidectomy may be carried out as primary treatment . The type and extent of the surgery depend on the diagnosis, goal of surgery , and prognosis.,Surgical Indications,A very large goiter or a multinodular goiter with relatively low radioactive iodine uptake Malignant thyroid nodule P
16、sychologically or mentally incompetent patients,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
17、 can be achieved with radioiodine treatment.,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.,The neck is extended an
18、d a symmetrical, gently 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.,Complications after surgery,Dyspnea , asphyxia Injury of laryngeal nerve Spas
19、ms Thyroid crisis（甲状腺危象）,Haemorrhage Haematoma(血肿）formation Tracheal collapse（气管塌陷） Tracheal mucous accumulation Laryngeal or local tissue edema,Cause,Complications after surgery,Respiratory distress and haemorrhage. Difficulty in respiration which is the occurs withinafter the surgery .,most critic
20、al complication,48 hours,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.,Preventive interventions,A tracheostomy set (气管切开包）
21、is kept at the patients bedside at all times , and the surgeon is summoned at the first indication of respiratory distress.,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 behind the thyroid next to the
22、trachea. Talk as little as possible. Can be cured spontaneously, or by 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”,laryngospasm,Manage
23、ment,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,Thyroid crisis (storm),Reason: insufficient preoperative preparation , a release of large amounts of thyroid hormone , rare Outcome:
24、can lead to cardiac, hepatic or renal failure. Stressful factors: surgery , infection or trauma, pregnancy .,Time of occurring : the first 12 hours postoperative. Clinical manifestation: Tachycardia ( 130 bmp) T 39, sometimes 41 Exaggerated symptoms of hyperthyroidism Disturbances of a major system,
25、Gastrointestinal (diarrhea, abdominal pain) Neurologic (psychosis, somnolence, 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 th
26、e surgery until the BMR become normal.,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 thyroid hormone . Take KI solution 3ml orally , or put 10% iodine sodium 5ml into i
27、n 10% glucose, and give iv injection to the patient .,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 heart rate and to prevent vascular collapse ( 37 ) . A large amount of glucose are needed .,
28、Oxygen therapy : Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demandsCardiac problems : arterial fibrillation, and congestive heart failure, sympatholytic agents may be administered, such as propranolol (心得安),Preoperative care,Perfect preoperative care
29、Baseline information Pharmacologic therapy Mental support Nutrition Instruction,Pharmacologic therapy,It 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
30、 to 14 days before surgery to decrease thyroid vascularity and decrease bleeding .,2 to 5 drops 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
31、 until the time of operation and the patient became euthyroid . .,Requirement : euthyroid Patients 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,Nutrition,Several well-balanced meals of small amount, e
32、ven 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 encouraged.,Preoperative teaching,How to support the neck with the hands after surgery to prevent stress on the incision. Eye care and protec
33、tion may become necessary , correct instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed cornea.,Postoperative care,Position Observation Oxygen Nutrition Medication Health instruction,Observation,Cardiac and respiratory function are assessed by measuring vital
34、signs and cardiac output, ECG monitor, arterial blood gases. Surgical dressing are assessed periodically and reinforced when necessary, especially at the back of the neck for bleeding.,If there is a drain , approximately of drainage is expected at the 1st day. If there is no drainage, the drain must
35、 be checked for,50 ml,links or obstruction,Laryngeal nerve : The nurse should encourage voice test for 48 hours postoperatively with voice checks every 2 to 4 hours to make certain there is no laryngeal nerve damage.,Nutrition,Intravenous fluids are administered during the immediate postoperative pe
36、riod; water may be given by mouth as soon as nausea subsides. Cold fluids and ice may be taken better than hot fluids. No difficulty in swallowing , soft diet .,Medications,KI (potassium iodine)should be taken 3 times a day, 16 drops each time, reduce 1 drop day by day, until the condition being steady.Sedative are administered as prescribed for pain .,Health instruction,Knowledgeable about the signs and symptoms of complications that may occur.,iodine,
