ThyroidDisordersWordListThyroidectomy甲狀腺切除術Thyroidcrisis甲狀腺危象Atracheostomyset氣管切開包Tetamy手足抽搐ThyroidGlandItisapartoftheendocrine(內分泌)system,playsamajorroleinregulatingthebody'smetabolism.Section1Anatomy/physiologyofthyroidPlaceBloodsupplyNervessupplyFunctionsAnatomy/physiologyofthyroidLocatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峽部）Butterfly-shapedorgan5cmlong,3cmwide，30gTheparathyroidglands（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.Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神經(jīng)）

duringdissection.Produces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopmentCommondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲減）,tumours,cancerorgoitre（甲狀腺腫）.WhentheThyroidDoesn’tWorkHyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUpHypothyroidismTooLittleThyroidHormoneMetabolismSlowsDownHyperthyroidism

(甲狀腺功能亢進）DefinitionHyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:20~40yearsoldgroup.ClinicalManifestationGoiterExophthalmos(突眼征）IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve

(交感神經(jīng)）Cardiovascularalteration

Thethyroidcanbepalpatedforasymmetry(不對稱）

andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.Hyperthyroidism

Asaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.Nervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.Theskiniswarmandmoist,characteristicsalmoncolour(鮮肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.Tachycardia:＞160bpmanddownto80bpmduringsleep.Pulsepressureiswidened.Therecanbemuscularweaknessandatrophy(萎縮）,paralysis（癱瘓）.TSH（促甲狀腺激素）T3,T4Radioactiveiodineuptake（Ⅰ131）ThyroidscanMensurationofbasicmetabolismrate(BMR)TSH(Thyroid–StimulatingHormone)normalTSHreflectaeuthyroid(甲狀腺機能正常的）

state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.Mensurationof

BasicMetabolismRate(BMR)

Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate=(Pulserate+Pulsepressure)-111GradeNormal:±10%Slightlyabnormal:+20%~+30%Moderatelyabnormal:+30%~+60%Seriouslyabnormal:＞+60%TreatmentAntithyroiddrugs,radioactiveiodine,orthyroidectomy(甲狀腺切除術）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.SurgicalIndicationsAverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatientsSurgeryAportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.SurgeryIfapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.

Theneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（鎖骨）.Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.Complicationsaftersurgery

Dyspnea,asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis（甲狀腺危象）HaemorrhageHaematoma(血腫）formationTrachealcollapse（氣管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema

CauseComplicationsaftersurgery

Respiratorydistressandhaemorrhage.Difficultyinrespirationwhichistheoccurswithinafterthesurgery.mostcriticalcomplication48hoursManagementSurgicalevacuationisrequired.ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.

Preventiveinterventions

Atracheostomyset(氣管切開包）iskeptatthepatient’sbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.

InjuryoflaryngealnerveAnyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神經(jīng)）,whichliesjustbehindthethyroidnexttothetrachea.

Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.SpasmTheparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”laryngospasmManagementTemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸鈣

Thyroidcrisis(storm)Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rareOutcome:canleadtocardiac,hepaticorrenalfailure.Stressfulfactors:surgery,infectionortrauma,pregnancy.

Timeofoccurring:thefirst12hourspostoperative.Clinicalmanifestation:Tachycardia(＞130bmp)T＞39℃,sometimes＞41℃ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem

Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.MedicalManagementThephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.

200~400mgHydrocortisone氫化可的松isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal魯米納Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37℃).

Alargeamountofglucoseareneeded.Oxygentherapy:HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安)PreoperativecarePerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstructionPharmacologictherapy

Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.

2to5dropsofpotassiumiodidesolution(復方碘化鉀)orLugol’siodinesolution(盧戈氏液)aregiveninconjunctionwithpropylthiouracil(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid..Requirement: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NutritionSeveralwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.

PreoperativeteachingHowtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correct