1、甲状腺疾病英文版甲状腺疾病英文版Word ListvThyroid disorders 甲状腺病症vIsthmus 峡部vThyroxine 甲状腺素vTriiodothyronine 三碘甲状腺氨酸vParathyroid glands 甲状旁腺vCalcitonin 降钙素2甲状腺疾病英文版vRecurrent laryngeal nerve 喉返神经vHyperthyroidism 甲亢vHypothyroidism 甲减vGoitre 甲状腺肿vExophthalmos 突眼症vTremor 震颤vTSH 促甲状腺激素3甲状腺疾病英文版vThyroidectomy 甲状腺切除术vThy
2、roid crisis 甲状腺危象vA tracheostomy set 气管切开包vTetamy 手足抽搐4甲状腺疾病英文版Thyroid GlandIt is a part of the endocrine(内分泌内分泌)system,plays a major role in regulating the bodys metabolism.5甲状腺疾病英文版Section 1Anatomy/physiology of thyroid6甲状腺疾病英文版PlaceBlood supplyNerves supplyFunctionsAnatomy/physiology of thyroid 7
3、甲状腺疾病英文版vLocated in the lower neck anterior to the trachea.Two lateral lobes connected by an isthmus（峡部）（峡部）vButterfly-shaped organv 5cm long ,3cm wide，30gv The parathyroid glands（甲状旁腺）（甲状旁腺）lying on the dorsal side（背面）（背面）of the thyroid gland.8甲状腺疾病英文版vRich,from the superior and inferior thyroid ar
4、tery.vArtery:vThe arterial branches provide blood supply to other structures in the area.The interior thyroid artery provides branches to the pharynx,trachea and esophagus.vVein:1)The superior thyroid vein 2)The middle thyroid vein 3)The inferior thyroid vein 9甲状腺疾病英文版vThe nerves supplying the thyro
5、id originate from vagus(迷走神经）迷走神经）,innervate the epithelial cells（上皮细胞）（上皮细胞）of the follicles（滤（滤泡）泡）of the thyroid gland.vOne must be aware of the bilateral existence of a recurrent laryngeal nerve（喉（喉返神经）返神经）during dissection.10甲状腺疾病英文版vProduces,synthesizes,stores,and secretes Two Hormones Called
6、Thyroxine(T4)Thyronine(T3)vRegulates Metabolism so Your Cells Function ProperlyvAffects Every Cell in the Body,necessary for normal growth and development11甲状腺疾病英文版vCommon disorder:A deficiency of iodine vOther disorder:Autoimmune thyroid diseasevClassification:Hyperthyroidism(甲亢）甲亢）,hypothyroidism（
7、甲减）（甲减）,tumours,cancer or goitre（甲状腺肿）（甲状腺肿）.12甲状腺疾病英文版When the Thyroid Doesnt WorkHyperthyroidism Too Much Thyroid Hormone Metabolism Speeds UpHypothyroidism Too Little Thyroid Hormone Metabolism Slows Down13甲状腺疾病英文版Hyperthyroidism(甲状腺功能亢进）甲状腺功能亢进）14甲状腺疾病英文版Definition Hyperthyroidism is an imbalanc
8、e of metabolism caused by overproduction of thyroid hormone.15甲状腺疾病英文版vCause:Increased secretion of thyroid hormone.vFemales:males=4:1,it tends to affect males more severely.vIncidence:20 40 years old group.16甲状腺疾病英文版Clinical ManifestationGoiterExophthalmos (突眼征）突眼征）Increased metabolic rateIncreased
9、 function of sympathetic nerve(交感神经）交感神经）Cardiovascular alteration 17甲状腺疾病英文版 v The thyroid can be palpated for asymmetry(不对称）不对称）and size.v It may enlarge 3-4 times to its normal size.It is called goitre.18甲状腺疾病英文版Hyperthyroidism19甲状腺疾病英文版20甲状腺疾病英文版vAs a result of increased thyroid hormone producti
10、on,the client has an increased metabolic rate.vWeight loss despite increased appetite,fatigue,poor tolerance to heat,and profuse perspiration,menstrual irregularities.21甲状腺疾病英文版vNervous,restlessness,irritability,difficulty concentrating,emotional liability,mood swings,personality changes.vFine tremo
11、rs of the fingers and tongue,shaky handwriting,clumsiness,trouble in climbing stairs,or dyspnea possibly at rest.22甲状腺疾病英文版vThe skin is warm and moist,characteristic salmon colour(鲜肉色）鲜肉色）.vThe hair is fine and soft with premature grey and increased hair loss.vThe nails appear fragile with distal na
12、il separation from the nail bed.23甲状腺疾病英文版v Tachycardia:160 bpm and down to 80 bpm during sleep.v Pulse pressure is widened.vThere can be muscular weakness and atrophy(萎缩）萎缩）,paralysis（瘫痪）（瘫痪）.24甲状腺疾病英文版Diagnostic TestsTSH（促甲状腺激素）（促甲状腺激素）T3,T4Radioactive iodine uptake（131131）Thyroid scanMensuration
13、of basic metabolism rate(BMR)25甲状腺疾病英文版vTSH(ThyroidStimulating Hormone)normal TSH reflect a euthyroid(甲状腺机能正甲状腺机能正常的）常的）state.v Hyperthyroidism:TSH is low or absent.v In mild forms of hyperthyroidism:slightly abnormal.26甲状腺疾病英文版Thyroid scan Scan are helpful in determining location,size,shape,and ana
14、tomic function of the thyroid gland.27甲状腺疾病英文版Mensuration of Basic Metabolism Rate (BMR)vConditions:Early in the morning,empty stomach,at the time of rest vBasic Metabolism Rate =(Pulse rate+Pulse pressure)-11128甲状腺疾病英文版GradevNormal:10%vSlightly abnormal:+20%+30%vModerately abnormal:+30%+60%vSerious
15、ly abnormal:+60%29甲状腺疾病英文版TreatmentvAntithyroid drugs,radioactive iodine,or thyroidectomy(甲状腺切除术）甲状腺切除术）.vIndividualized and depends on the age and general state of health，the size of the goiter and the ability to obtain follow-up care.30甲状腺疾病英文版vPartial or complete thyroidectomy may be carried out
16、as primary treatment.vThe type and extent of the surgery depend on the diagnosis,goal of surgery,and prognosis.31甲状腺疾病英文版Surgical IndicationsvA very large goiter or a multinodular goiter with relatively low radioactive iodine uptakevMalignant thyroid nodule vPsychologically or mentally incompetent p
17、atients32甲状腺疾病英文版SurgeryvA portion of the thyroid gland is removed,but a total thyroidectomy may be performed(expensive,risks).vIndications for subtotal thyroidectomy:the main advantages are rapid control of the disease and a lower incidence of hypothyroidism than can be achieved with radioiodine tr
18、eatment.33甲状腺疾病英文版SurgeryvIf a partial thyroidectomy is done,the remaining thyroid tissue should provide adequate amounts of thyroid hormones.vIf a complete thyroidectomy is done,the client will require thyroid hormone replacement for a lifetime.34甲状腺疾病英文版The neck is extended and a symmetrical,gentl
19、y curved incision is made 1 to 2 cm above the clavicle（锁骨）（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.35甲状腺疾病英文版Complications after surgeryDyspnea,asphyxiaInjury of laryngeal nerveSpasms Thyroid crisi
20、s（甲状腺危象）（甲状腺危象）36甲状腺疾病英文版HaemorrhageHaematoma(血肿）血肿）formation Tracheal collapse（气管塌陷）（气管塌陷）Tracheal mucous accumulationLaryngeal or local tissue edemaCause37甲状腺疾病英文版Complications after surgeryv Respiratory distress and haemorrhage.Difficulty in respiration which is the occurs within after the surger
21、y.38甲状腺疾病英文版Managementv Surgical evacuation is required.v The first aid by the bed A.cut off the suture B.opened the wound wide C.removed the hematoma v The trachea is cut,apply oxygen v Send to the operation room for further treatment.39甲状腺疾病英文版Preventive interventionsvA tracheostomy set(气管切开包）气管切开
22、包）is kept at the patients bedside at all times,and the surgeon is summoned at the first indication of respiratory distress.40甲状腺疾病英文版Injury of laryngeal nervevAny voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神经）（喉返神经）,which lies just behind the thyroi
23、d next to the trachea.vTalk as little as possible.Can be cured spontaneously,or by physical therapy.41甲状腺疾病英文版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
24、”42甲状腺疾病英文版ManagementvTemporaryvLimit taking of meat,eggs which are high in phosphorus（磷）（磷）vUse of the sedative to control the pain vIntravenous administration of calcium gluconate葡萄糖酸钙葡萄糖酸钙 43甲状腺疾病英文版Thyroid crisis(storm)vReason:insufficient preoperative preparation,a release of large amounts of t
25、hyroid hormone,rare vOutcome:can lead to cardiac,hepatic or renal failure.vStressful factors:surgery,infection or trauma,pregnancy.44甲状腺疾病英文版vTime of occurring:the first 12 hours postoperative.vClinical manifestation:1.Tachycardia (130 bmp)2.T 39,sometimes 413.Exaggerated symptoms of hyperthyroidism
26、4.Disturbances of a major system 45甲状腺疾病英文版u Gastrointestinal (diarrhea,abdominal pain)u Neurologic (psychosis,somnolence,coma)u Cardiovascular (edema,chest pain,dyspnea,palpitations)46甲状腺疾病英文版vFatalness:The client may develop congestive heart failure and die.vPreventions:The key is to do the preope
27、rative preparation sufficiently,and perform the surgery until the BMR become normal.47甲状腺疾病英文版Medical ManagementvThe physician must be informed immediately.vTransfer the patient to the intensive care for closer monitoring vIodine is administered to decrease the output of thyroid hormone.Take KI solu
28、tion 3ml orally,or put 10%iodine sodium 5ml into in 10%glucose,and give iv injection to the patient.48甲状腺疾病英文版nOxygen therapy:Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demandsn Cardiac problems:arterial fibrillation,and congestive heart failure,sympa
29、tholytic agents may be administered,such as propranolol(心得安心得安)50甲状腺疾病英文版Preoperative carePerfect preoperative careBaseline informationPharmacologic therapyMental supportNutritionInstruction 51甲状腺疾病英文版Pharmacologic therapynIt is necessary for surgical treatment,but it can not act as a therapuetic me
30、dication.nEncourages 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.52甲状腺疾病英文版n 2 to 5 drops of potassium iodide solution(复方复方碘化钾碘化钾)or Lugols iodine solution(卢戈氏液卢戈氏液)a
31、re given in conjunction with propylthiouracil (丙基硫尿嘧啶丙基硫尿嘧啶)to decrease the friability and vascularity of the thyroid,it should be applied until the time of operation and the patient became euthyroid.53甲状腺疾病英文版nRequirement:euthyroid nPatients mood is steady,the sleep takes a favorable turn,gain weig
32、ht,pulse rate 90 times/min,Basic Metabolism Rate +20%.n情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复54甲状腺疾病英文版NutritionnSeveral well-balanced meals of small amount,even up to six meals a day.n Highly seasoned foods and stimulants,such as coffee,tea,cola,and alcohol are discouraged.n High-calorie,
33、high-protein foods are encouraged.55甲状腺疾病英文版Preoperative teachingnHow to support the neck with the hands after surgery to prevent stress on the incision.nEye care and protection may become necessary,correct instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed c
34、ornea.56甲状腺疾病英文版Postoperative carePositionObservationOxygenNutritionMedicationHealth instruction57甲状腺疾病英文版Observationn Cardiac and respiratory function are assessed by measuring vital signs and cardiac output,ECG monitor,arterial blood gases.n Surgical dressing are assessed periodically and reinforc
35、ed when necessary,especially at the back of the neck for bleeding.58甲状腺疾病英文版nIf there is a drain,approximately of drainage is expected at the 1st day.nIf there is no drainage,the drain must be checked for59甲状腺疾病英文版vLaryngeal nerve:The nurse should encourage voice test for 48 hours postoperatively wi
36、th voice checks every 2 to 4 hours to make certain there is no laryngeal nerve damage.60甲状腺疾病英文版Nutritionn Intravenous fluids are administered during the immediate postoperative period;water may be given by mouth as soon as nausea subsides.n Cold fluids and ice may be taken better than hot fluids.n
37、No difficulty in swallowing,soft diet.61甲状腺疾病英文版Medicationsn 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.n Sedative are administered as prescribed for pain.62甲状腺疾病英文版Health instructionnKnowledgeable about the signs and symptoms of complications that may occur.iodine63甲状腺疾病英文版
