甲状腺疾病(英文版)课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,Thyroid Disorders,1,.,Thyroid Disorders1.,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,2,.,Word ListThyroid disor,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,3,.,Recurrent laryngeal nerve,Thyroidectomy,甲状腺切除术,Thyroid crisis,甲状腺危象,A tracheostomy set,气管切开包,Tetamy,手足抽搐,4,.,Thyroidectomy,Thyroid Gland,It is a part of the endocrine,(,内分泌,),system, plays a major role in regulating the bodys metabolism.,5,.,Thyroid GlandIt is a part of t,Section 1,Anatomy/physiology of thyroid,6,.,Section 1Anatomy/physiology of,Place,Blood supply,Nerves supply,Functions,Anatomy/physiology of thyroid,7,.,PlaceAnatomy/physiology of thy,Located in the,lower neck,anterior to the trachea.,Two lateral lobes,connected by an isthmus,（峡部）,Butterfly- shaped organ,5cm long , 3cm wide,，,30g,The parathyroid glands,（甲状旁腺）,lying on the dorsal side,（背面）,of the thyroid gland.,8,.,Located in the lower neck ante,Rich, from the superior and inferior thyroid artery.,Artery,:,The arterial branches 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,3) The,inferior,thyroid vein,9,.,Rich , from the superior and i,The nerves supplying the thyroid originate from vagus,(,迷走神经）, innervate the epithelial cells,（上皮细胞）,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.,10,.,The nerves supplying the thyro,Produces, synthesizes , stores , and secretes Two Hormones,Called,Thyroxine (T4),Thyronine (T3),Regulates Metabolism,so Your Cells Function Properly,Affects Every Cell in the Body, necessary for normal growth and development,11,.,Produces, synthesizes , stores,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）,.,12,.,Common disorder: A deficiency,When the Thyroid Doesnt Work,Hyperthyroidism,Too Much Thyroid Hormone,Metabolism Speeds Up,Hypothyroidism,Too Little Thyroid Hormone,Metabolism Slows Down,13,.,When the Thyroid Doesnt WorkH,Hyperthyroidism,(,甲状腺功能亢进）,14,.,Hyperthyroidism(甲状腺功能亢进）14.,Definition,Hyperthyroidism is an imbalance of,metabolism,caused by,overproduction,of,thyroid hormone.,15,.,Definition Hyperthyroidism i,Cause:,Increased secretion of thyroid hormone.,Females : males = 4 : 1, it tends to affect males more severely .,Incidence,: 20 40 years old group .,16,.,Cause: Increased secretion of,Clinical Manifestation,Goiter,Exophthalmos,(,突眼征）,Increased metabolic rate,Increased function of sympathetic,nerve,(,交感神经）,Cardiovascular alteration,17,.,Clinical ManifestationGoiter1,The thyroid can be palpated for,asymmetry,(,不对称）,and size.,It may enlarge,3-4 times,to its normal,size. It is called goitre.,18,.,The thyroid can be palpated,Hyperthyroidism,19,.,Hyperthyroidism19.,20,.,20.,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 .,21,.,As a result of increased thyro,Nervous, restlessness, 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.,22,.,Nervous, restlessness, irritab,The skin,is warm and moist , characteristic,salmon colour,(,鲜肉色）,.,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 .,23,.,The skin is warm and moist , c,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）,.,24,.,Tachycardia : 160 bpm and d,Diagnostic Tests,TSH,（促甲状腺激素）,T,3, T,4,Radioactive iodine uptake,（,131,）,Thyroid scan,Mensuration of basic metabolism,rate (BMR),25,.,Diagnostic TestsTSH（促甲状腺激素）25.,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 .,26,.,TSH (ThyroidStimulating Hormo,Thyroid scan,Scan are helpful in determining location , size, shape, and anatomic function of the thyroid gland.,27,.,Thyroid scan27.,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) - 111,28,.,Mensuration of Basic Metabol,Grade,Normal,: 10%,Slightly,abnormal: +20% +30%,Moderately,abnormal: +30% +60%,Seriously,abnormal:,+60%,29,.,GradeNormal: 10% 29.,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.,30,.,TreatmentAntithyroid drugs , r,Partial 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.,31,.,Partial or complete thyroidect,Surgical Indications,A very large goiter,or a multinodular goiter with relatively low radioactive iodine uptake,Malignant,thyroid nodule,Psychologically or mentally incompetent,patients,32,.,Surgical IndicationsA very lar,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 can be achieved with radioiodine treatment.,33,.,SurgeryA portion of the thyroi,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.,34,.,SurgeryIf a partial thyroidect,The neck is extended and 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,.,35,.,The neck is extended and a sym,Complications after surgery,Dyspnea , asphyxia,Injury of laryngeal nerve,Spasms,Thyroid crisis,（甲状腺危象）,36,.,Complications after surgeryDy,Haemorrhage,Haematoma,(,血肿）,formation,Tracheal collapse,（气管塌陷）,Tracheal mucous accumulation,Laryngeal or local tissue edema,Cause,37,.,HaemorrhageCause37.,Complications after surgery,Respiratory distress and haemorrhage.,Difficulty in respiration,which is the,occurs within,after the surgery .,most critical complication,48 hours,38,.,Complications after surgery R,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.,39,.,Management Surgical evacuation,Preventive interventions,A tracheostomy set,(,气管切开包）,is kept at the patients bedside at all times , and the surgeon is summoned at the first indication of respiratory distress.,40,.,Preventive interventionsA tra,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 trachea.,Talk as little as possible.,Can be cured spontaneously, or by physical therapy.,41,.,Injury of laryngeal nerveAny v,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,42,.,Spasm The parathyroid glands,Management,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,43,.,ManagementTemporary43.,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:,surgery , infection or trauma, pregnancy .,44,.,Thyroid crisis (storm)Reason:,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,45,.,Time of occurring : the first,Gastrointestinal,(diarrhea, abdominal pain),Neurologic,(psychosis, somnolence, coma),Cardiovascular,(edema, chest pain, dyspnea, palpitations),46,.,Gastrointestinal 46.,Fatalness:,The client may 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,.,47,.,Fatalness: The client may deve,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 in,10% glucose, and give iv injection to the patient .,48,.,Medical ManagementThe physicia,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 .,49,.,200400mg Hydrocortisone氢化可的松,Oxygen therapy :,Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demands,Cardiac problems :,arterial fibrillation, and congestive heart failure,sympatholytic agents may be administered,such as propranolol,(,心得安,),50,.,Oxygen therapy : Humidified ox,Preoperative care,Perfect preoperative care,Baseline information,Pharmacologic therapy,Mental support,Nutrition,Instruction,51,.,Preoperative carePerfect preop,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 to 14 days before surgery,to decrease thyroid vascularity and decrease bleeding .,52,.,Pharmacologic therapyIt is ne,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 until the,time of operation,and the patient became,euthyroid,.,.,53,.,2 to 5 drops of potassium iod,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,54,.,Requirement : euthyroid 54.,Nutrition,Several well-balanced meals of small amount, even 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.,55,.,NutritionSeveral well-balanced,Preoperative teaching,How to,support the neck,with the 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.,56,.,Preoperative teachingHow to su,Postoperative care,Position,Observation,Oxygen,Nutrition,Medication,Health instruction,57,.,Postoperative carePosition57.,Observation,Cardiac and respiratory function,are assessed by measuring vital 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.,58,.,Observation Cardiac and respir,If there is,a drain, approximately of drainage is expected at the,1st day,.,If there is,no drainage, the drain must be checked for,50 ml,links or obstruction,59,.,If there is a drain , approxim,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.,60,.,Laryngeal nerve : The nurse sh,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 hot fluids.,No difficulty in swallowing ,soft diet,.,61,.,Nutrition Intravenous fluids,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 .,62,.,Medications KI (potassium iodi,Health instruction,K,nowledgeable about the,signs and,symptoms of complications,that may occur.,iodine,63,.,Health instructionKnowledgeabl,