数字化医院建设

Graves' Disease
Autoimmune systemic disorder Thyroid receptor antibody binding to and
stimulating the TSH receptor Excessive synthesis and secretion of thyroid
or direct laryngoscopy
Nontoxic Goiter
Ultrasound
– How many nodules? – Bilateral? – Ultrasound characteristics
Nontoxic Goiter
CT scan
– Neck and chest, especially substernal thyroid – Rare intrathoracic or aberrant thyroid
Monozygotic twins show 50% concordance rates Incidence peaks from ages 20-40 Incidence is similar in whites and Asians, but is
somewhat decreased for African Americans
Rare side effect: agranulocytosis
– Radioactive iodine
75% of treated pts become hypothyroid
– Surgery
Toxic Adenoma or TMNG
– RAI or surgery
Surgery
Hyperthroidism
hypothyroidism or hyperthyroidism Appropriate treatment options for each particular
patient
Nontoxic Goiter
Taking history
Asymptomatic neck mass
– A cough, shortness of breath, stridor, or hoarseness – Choking or aspiration, dysphagia, or pain – Symptoms of hyperthyroidism – Whether the patient has cosmetic concerns
emotional lability In women, irregular menses
Hyperthyroidism
Clinical findings
Tremor, tachycardia (A. fib), Goiter, lid lag, proptosis, periorbital edema,
Surgery for hyperthyroidism
Preoperative preparation
Absolutely required antithyroid drugs, for 3 to 6 weeks
– with a goal of nearly normalizing the T3 and T4
Symptoms
Hyperthyroidism
Heat intolerance, sweating, palpitations, fatigue Weight loss, diaphoresis, increased stool
frequency Muscle weakness, anxiety, insomnia Nervousness or restlessness; irritability,
– Symptoms
Local compression Secondary hyperthyroidisim
– Any suspicious or malignant lesion – Cosmetic reasons
Radioiodine therapy, high risk of pts Thyroid hormone suppression (not for sporadic
Nontoxic Goiter
Clinical thinking
Whether the patient has local symptoms Whether the goiter is toxic or nontoxic Whether any of the nodules harbor a cancer The number and bilaterality of the nodules TSH level, differential diagnosis of
– thyroid surgery became safe
Theodore Kocher, a Nobel Prize in 1909
– From Bern, Switzerland – His pioneering efforts in thyroid surgery
Primary Hyperthyroidsim Grave’s Disease
Nontoxic Goiter
Fine needle aspiration (FNA)
– Suspicious malignent goiter
Treatment
Nontoxic Goiter
Iodine diet replacement (endemic goitor) Surgical resection
Defined as an enlargement of the thyroid gland Endemic when it involves more than 10% of the
population The majority, secondary to iodine deficiency Especially found in high mountain regions
Thyroid cancer
Introduction
Thyroid cancer
Leabharlann Baidu
The most common, 95% of all endocrine cancers Increasing faster than any other cancer More than 90% , well differentiated Good long-term prognosis
Clinical Statistics
Graves Disease is the most common cause of hyperthyroidism (60-80%) of all cases
Females are affected more frequently than men 10:1.5
Propranolol or atenolol rapidly controls the adrenergic side effects of excess T4 and T3
– tachycardia, tremor, and diaphoresis
Lugol's solution rapidly but temporarily restores normal thyroid function and reduces thyroid gland vascularity
exophthalmos; chemosis; hyperreflexia Warm, moist skin; dermopathy; and pretibial
edema, osteoporosis
Exopthalamos in Graves Disease
Lid Lag in Graves Disease
Hyperthyroidism—treatment
Beta-blockers: control sxs
– Propranolol decr peripheral T4 -> T3 conversion
Graves’ Dz
– PTU (safe in pregnancy) or methimazole
Thyroid disease
Nontoxic goiter Hyperthyroidism Thyroid Cancer Thyroiditis
Nontoxic Goiter
Goiter from the French (goitre) and Latin (guttur), both meaning throat
Surgical complications
Bleeding Recurrent Laryngeal Nerve Damage Hypoparathyroidism and Hypocalcemia Superior laryngeal nerve damage Thyroid storm
Thyroid cancer
Clinical Presentation
Most, clinically with a palpable nodule Usually asymptomatic Rare cases, with hoarseness, pain, dysphagia,
Surgical approach
– Bilateral near-total or total thyroidectomy
Indication of surgery (In China)
– Compressive symptoms – Secondary or adenoma – Recurrence of medicine or iodine-131 – No efficiency of medicine – Second trimester of pregnancy
hormone Usually diffusely and symmetrically enlarged
and firm
Hyperthyroidism—uptake
A. Normal B. Graves’ Dz C. Toxic Multinodular
Goiter D. Toxic Adenoma E. Thyroiditis
From iodine deficiency region
Nontoxic Goiter
Physical examination
Whether the goiter is confined to the neck Whether it has a substernal component Whether tracheal deviation is present The size and consistency of the goiter The mobility of the vocal cords by either indirect
Nontoxic Goiter
History of Thyroid Surgery
First thyroidectomy, in Paris in 1791 by PierreJoseph Desault
Antisepsis, hemostasis, and general anesthesia in the 1840s
goiter)
Sporadic Nontoxic Goiter
Asymptomatic Euthyroid Most bilaterally No efficiency of thyroid hormone replacement High recurrence postoperatively 30%~40%
Thyroid disease
Libo Li MD Department of General Surgery
Sir Run Run Shaw Hospital School of medicine, Zhejiang University
Anatomy of Thyroid
Anatomy of Thyroid