甲狀腺疾病英文版

1、,Thyroid Disorders,Word List,Thyroid disorders 甲狀腺病癥Isthmus 峽部Thyroxine 甲狀腺素Triiodothyronine 三碘甲狀腺氨酸Parathyroid glands

2、 甲狀旁腺Calcitonin 降鈣素,Recurrent laryngeal nerve 喉返神經(jīng)Hyperthyroidism 甲亢Hypothyroidism 甲減Goitre

3、 甲狀腺腫Exophthalmos 突眼癥Tremor 震顫TSH 促甲狀腺激素,Thyroidectomy 甲狀腺切除術(shù)Thyroid

4、 crisis 甲狀腺危象A tracheostomy set 氣管切開包Tetamy 手足抽搐,,Thyroid Gland,It is a part of the endocrine (內(nèi)分泌) system, plays a major role in regulating the body

5、's metabolism.,,Section 1,Anatomy/physiology of thyroid,PlaceBlood supplyNerves supplyFunctions,Anatomy/physiology of thyroid,Located in the lower neck anterior to the trachea. Two lateral lobes connected by an is

6、thmus（峽部）Butterfly- shaped organ 5cm long , 3cm wide ，30g The parathyroid glands（甲狀旁腺） lying on the dorsal side（背面） of the thyroid gland.,Rich , from the superior and inferior thyroid artery.Artery: The arterial b

7、ranches 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

8、 3) The inferior thyroid vein,The nerves supplying the thyroid originate from vagus (迷走神經(jīng)）, innervate the epithelial cells （上皮細胞） of the follicles（濾泡） of the thyroid gland. One must be aware of the bilateral existenc

9、e of a recurrent laryngeal nerve （喉返神經(jīng)） during dissection.,,Produces, synthesizes , stores , and secretes Two Hormones Called Thyroxine (T4)Thyronine (T3)Regulates Metabolism so Your Cells Function ProperlyAffects

10、 Every Cell in the Body, necessary for normal growth and development,Common disorder: A deficiency of iodine Other disorder : Autoimmune thyroid diseaseClassification: Hyperthyroidism(甲亢）, hypothyroidism（甲減）, tumours ,

11、 cancer or goitre（甲狀腺腫）.,When the Thyroid Doesn’t Work,Hyperthyroidism Too Much Thyroid Hormone Metabolism Speeds Up,Hypothyroidism Too Little Thyroid Hormone Metabolism Slows Down,Hyperthyroidism(甲狀腺功能亢進）,Defin

12、ition,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 severely . Incide

13、nce : 20~ 40 years old group .,Clinical Manifestation,GoiterExophthalmos (突眼征）Increased metabolic rateIncreased function of sympathetic nerve (交感神經(jīng)）Cardiovascular alteration,,The thyroid can be palpated for

14、asymmetry (不對稱） and size. It may enlarge 3-4 times to its normal size. It is called goitre.,Hyperthyroidism,,,,As a result of increased thyroid hormone production, the client has an increased metabolic rate. Wei

15、ght loss despite increased appetite , fatigue , poor tolerance to heat , and profuse perspiration, menstrual irregularities .,Nervous, restlessness, irritability, difficulty concentrating , emotional liability, mood swin

16、gs, 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 ( 鮮肉色） .

17、The 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

18、 is widened. There can be muscular weakness and atrophy (萎縮）, paralysis（癱瘓）.,Diagnostic Tests,TSH（促甲狀腺激素）T3 , T4Radioactive iodine uptake（Ⅰ131）Thyroid scanMensuration of basic metabolism rate (BMR),,TSH (Thyroid–St

19、imulating Hormone) normal TSH reflect a euthyroid (甲狀腺機能正常的） state. Hyperthyroidism : TSH is low or absent . In mild forms of hyperthyroidism : slightly abnormal .,Thyroid scan Scan are helpful in determining

20、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 = (

21、 Pulse rate + Pulse pressure) - 111,Grade,Normal: ±10% Slightly abnormal: +20% ~ +30% Moderately abnormal: +30% ~ +60%Seriously abnormal: ＞+60%,Treatment,Antithyroid drugs , radioactive iodine, or thyroidect

22、omy (甲狀腺切除術(shù)）. 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 as primary treatment

23、 .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 uptakeMalignant th

24、yroid nodule Psychologically 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 : th

25、e main advantages are rapid control of the disease and a lower incidence of hypothyroidism than can be achieved with radioiodine treatment.,Surgery,If a partial thyroidectomy is done , the remaining thyroid tissue should

26、 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 m

27、ade 1 to 2 cm above the clavicle（鎖骨）.,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 , asp

28、hyxiaInjury of laryngeal nerveSpasms Thyroid crisis（甲狀腺危象）,,HaemorrhageHaematoma(血腫）formation Tracheal collapse（氣管塌陷）Tracheal mucous accumulationLaryngeal or local tissue edema,Cause,Complications after surgery,Re

29、spiratory distress and haemorrhage. Difficulty in respiration which is the occurs within after the surgery .,most critical complication,48 hours,Managem

30、ent,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 roo

31、m for further treatment.,Preventive interventions,A tracheostomy set (氣管切開包）is kept at the patient’s bedside at all times , and the surgeon is summoned at the first indication of respiratory distress.,Injury of laryngeal

32、 nerve,Any voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神經(jīng)）, which lies just behind the thyroid next to the trachea. Talk as little as possible. Can be cured spontaneous

33、ly, 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

34、feet and muscular twitching “tetany”,,,,,laryngospasm,,Management,TemporaryLimit taking of meat , eggs which are high in phosphorus（磷）Use of the sedative to control the pain Intravenous administration of cal

35、cium gluconate葡萄糖酸鈣,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

36、: 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 hyperthyroidismDistur

37、bances of a major system,Gastrointestinal (diarrhea, abdominal pain) Neurologic (psychosis, somnolence, coma) Cardiovascular (edema, chest pain, dyspnea, palpitations),Fatalness: The client ma

38、y 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 Management,The physician must be informe

39、d 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%

40、 glucose, and give iv injection to the patient .,200~400mg Hydrocortisone氫化可的松 is prescribed to treat shock or adrenal insufficiency .The usage of sedative( luminal魯米納 Q6-8h)Reduce body temperature and heart rate and t

41、o prevent vascular collapse ( 37 ℃) . A large amount of glucose are needed .,Oxygen therapy : Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demands Cardiac problems : ar

42、terial fibrillation, and congestive heart failure, sympatholytic agents may be administered, such as propranolol (心得安),Preoperative care,Perfect preoperative careBaseline informationPharmacologic therapyMental support

43、NutritionInstruction,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

44、have been prescribed 10 to 14 days before surgery to decrease thyroid vascularity and decrease bleeding .,2 to 5 drops of potassium iodide solution(復(fù)方碘化鉀) or Lugol’s iodine solution (盧戈氏液) are given in conjunction with p

45、ropylthiouracil (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's mood is

46、steady , the sleep takes a favorable turn, gain weight , pulse rate < 90 times /min , Basic Metabolism Rate < +20%.情緒穩(wěn)定、睡眠正常、體重增加、心跳正常、代謝恢復(fù),Nutrition,Several well-balanced meals of small amount, even up to six mea

47、ls 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

48、 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.,Postopera

49、tive care,PositionObservationOxygenNutritionMedicationHealth instruction,Observation,Cardiac and respiratory function are assessed by measuring vital signs and cardiac output, ECG monitor, arterial blood gases. Su

50、rgical 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

51、 is no drainage, the drain must 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

52、 no laryngeal nerve damage.,Nutrition,Intravenous fluids are administered during the immediate postoperative period; water may be given by mouth as soon as nausea subsides. Cold fluids and ice may be taken better than

53、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 admin