甲狀腺疾病(英文版)

ThyroidDisordersThyroiddisorders甲狀腺病癥01Isthmus峽部02Thyroxine甲狀腺素03Triiodothyronine三碘甲狀腺氨酸04Parathyroidglands甲狀旁腺05Calcitonin降鈣素06WordListRecurrentlaryngealnerve喉返神經(jīng)Hyperthyroidism甲亢Hypothyroidism甲減Goitre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)01Atracheostomyset氣管切開包03Thyroidcrisis甲狀腺危象02Tetamy手足抽搐04ThyroidGlandItisapartoftheendocrine(內(nèi)分泌)system,playsamajorroleinregulatingthebody'smetabolism.Section1Anatomy/physiologyofthyroidAnatomy/physiologyofthyroidPlaceBloodsupplyNervessupplyFunctions01020304Locatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峽部）5cmlong,3cmwide，30gButterfly-shapedorganTheparathyroidglands（甲狀旁腺）lyingonthedorsalside（背面）ofthethyroidgland.Rich,fromthesuperiorandinferiorthyroidartery.Artery:Thearterialbranchesprovidebloodsupplytootherstructuresinthearea.Theinteriorthyroidarteryprovidesbranchestothepharynx,tracheaandesophagus.Vein:1)Thesuperiorthyroidvein2)Themiddlethyroidvein3)TheinferiorthyroidveinThenervessupplyingthethyroidoriginatefromvagus(迷走神經(jīng)）,innervatetheepithelialcells（上皮細胞）ofthefollicles（濾泡）ofthethyroidgland.01Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神經(jīng)）duringdissection.02Produces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopmentCommondisorder:Adeficiencyofiodine01Classification:Hyperthyroidism(甲亢）,hypothyroidism（甲減）,tumours,cancerorgoitre（甲狀腺腫）.03Otherdisorder:Autoimmunethyroiddisease02WhentheThyroidDoesn’tWorkHyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUpHypothyroidismTooLittleThyroidHormoneMetabolismSlowsDownHyperthyroidism

(甲狀腺功能亢進）DefinitionHyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:20~40yearsoldgroup.ClinicalManifestationGoiter01Exophthalmos(突眼征）02Increasedmetabolicrate03Increasedfunctionofsympatheticnerve(交感神經(jīng)）04Cardiovascularalteration05Thethyroidcanbepalpatedforasymmetry(不對稱）andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.010302HyperthyroidismAsaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.Nervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.12Theskiniswarmandmoist,characteristicsalmoncolour(鮮肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.1Tachycardia:＞160bpmanddownto80bpmduringsleep.2Pulsepressureiswidened.3Therecanbemuscularweaknessandatrophy(萎縮）,paralysis（癱瘓）.TSH（促甲狀腺激素）T3,T4Radioactiveiodineuptake（Ⅰ131）ThyroidscanMensurationofbasicmetabolismrate(BMR)12345DiagnosticTestsNo.3TSH(Thyroid–StimulatingHormone)normalTSHreflectaeuthyroid(甲狀腺機能正常的）state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.No.2No.1ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.Mensurationof

BasicMetabolismRate(BMR)Conditions:Earlyinthemorning,emptystomach,atthetimeofrest1BasicMetabolismRate=(Pulserate+Pulsepressure)-1112Normal:±10%1Slightlyabnormal:+20%~+30%2Moderatelyabnormal:+30%~+60%3Seriouslyabnormal:＞+60%4GradeAntithyroiddrugs,radioactiveiodine,orthyroidectomy(甲狀腺切除術(shù)）.01Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.02TreatmentPartialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.SurgicalIndicationsAverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatientsAportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.SurgeryIfapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.12SurgeryTheneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（鎖骨）.Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.12ComplicationsaftersurgeryInjuryoflaryngealnerve02Spasms03Dyspnea,asphyxia01Thyroidcrisis（甲狀腺危象）04HaemorrhageHaematoma(血腫）formationTrachealcollapse（氣管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema01Cause02ComplicationsaftersurgerymostcriticalcomplicationRespiratorydistressandhaemorrhage.Difficultyinrespirationwhichistheoccurswithinafterthesurgery.hours1234ManagementSurgicalevacuationisrequired.ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.

PreventiveinterventionsAtracheostomyset(氣管切開包）iskeptatthepatient’sbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.InjuryoflaryngealnerveAnyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神經(jīng)）,whichliesjustbehindthethyroidnexttothetrachea.01Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.02SpasmTheparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”laryngospasmSTEP1STEP2STEP3STEP4TemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸鈣ManagementThyroidcrisis(storm)Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rare12Stressfulfactors:surgery,infectionortrauma,pregnancy.3Outcome:canleadtocardiac,hepaticorrenalfailure.Timeofoccurring:thefirst12hourspostoperative.DisturbancesofamajorsystemExaggeratedsymptomsofhyperthyroidismTachycardia(＞130bmp)Clinicalmanifestation:39℃,sometimes＞41℃Gastrointestinal(diarrhea,abdominalpain)Neurologic(psychosis,somnolence,coma)Cardiovascular(edema,chestpain,dyspnea,palpitations)Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.12Thephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.MedicalManagement200~400mgHydrocortisone氫化可的松isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal魯米納Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37℃).Alargeamountofglucoseareneeded.Oxygentherapy:HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsACardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安)BPreoperativecarePerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstructionPharmacologictherapyItisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.to5dropsofpotassiumiodidesolution(復(fù)方碘化鉀)orLugol’siodinesolution(盧戈氏液)aregiveninconjunctionwithpropylthiouracil(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid..0102Requirement:euthyroidPatient'smoodissteady,thesleeptakesafavorableturn,gainweight,pulserate<90times/min,BasicMetabolismRate<+20%.情緒穩(wěn)定、睡眠正常、體重增加、心跳正常、代謝恢復(fù)NutritionNo.3Severalwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.No.2No.1PreoperativeteachingHowtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.01Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.02PostoperativecarePositionObservationOxygenNutritionMedicationHe