扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 16. Neck Diseases

Thyroid Diseases

Thyroid Diseases

TopicsThyroid diseaseaspectThyroid anatomyPhysiology of thyroidHyperthyroidismThyroiditisSimplegoiterThyroid adenomaThyroid carcinomaPrimary hyperparathyroidism

 Thyroid disease aspect  Thyroid anatomy  Physiology of thyroid  Hyperthyroidism  Thyroiditis  Simple goiter  Thyroid adenoma  Thyroid carcinoma  Primary hyperparathyroidism Topics

XThyroid disease aspectthyroid disorderextremely commoninpopulation1%womenhypothyroidism1%hyperthyroidism3%-4%thyroid nodulesat some time in human live span

Thyroid disease aspect extremely common in population  hypothyroidism 1% women  hyperthyroidism 1%  thyroid nodules 3%-4% at some time in human live span thyroid disorder

GrossAnatomycolor reddish yellowweight 1.5gmnewbornchildnormal adult thyroid15~30gmtwolaterallobes4-5cmlongand2-3cmwide

Gross Anatomy  color reddish yellow  weight 1.5 gm newborn child normal adult thyroid 15~30 gm  two lateral lobes 4-5 cm long and 2-3 cm wide

a bilobed structure that liesimmediately next to thethyroid cartilage in aposition anterior and lateralto the junctionof the larynxandtracheaisthmus,situated inadirectly anterior position atorbelowthe cricoidcartilage

• a bilobed structure that lies immediately next to the thyroid cartilage in a position anterior and lateral to the junction of the larynx and trachea. • isthmus, situated in a directly anterior position at or below the cricoid cartilage

TheRLNs(recurrentlaryngeal nerve)originate from the Vagus Nervecircle around the subclavian artery(right)and aortic arch (left)，ascendsuperiorly and medially toward thetracheoesophageal groove,enterthelarynxdeep tothe inferior constrictormuscles and posterior to thecricothyroidjoint.The right RLN enters the root of theneckfromamorelateraldirection.Itscourse is less predictable

• The RLNs(recurrent laryngeal nerve) originate from the Vagus Nerve. circle around the subclavian artery (right) and aortic arch (left) , ascend superiorly and medially toward the tracheoesophageal groove, enter the larynx deep to the inferior constrictor muscles and posterior to the c r i c o t h y r o i d j o i n t . • The right RLN enters the root of the neck from a more lateral direction. Its c ou r s e i s l e s s pr e d i c t a b l e

Physiologyproduce thyroid hormonedevelop,regulatemetabolismnecessary for:Metabolismistheprocesses ofenergygrowthgenerationandusebraindevelopmentmetabolism&organ activity

Physiology produce thyroid hormone  develop, regulate metabolism  necessary for:  growth  brain development  metabolism & organ activity

Physiologythyroid hormonesiodinated amino acids thyroxine (T)o3,5,3'-triiodothyronine(T3)synthesized and storedin thyroid follicular cellintegral part ofthyroglobulin

Physiology thyroid hormones  iodinated amino acids thyroxine (T4 ) 3,5,3’-triiodothyronine (T3 ) synthesized and stored in thyroid follicular cell integral part of thyroglobulin

Physiologythyroid hormones in the plasmacirculates as freeamino acidsonly in the free formplays role for metabolismregulationHypothalamusunder anterior pituitary thyrotropinTRHthyroid-stimulating h.(TSH)Pitultary Giand-TSHfeedbackT3.T4T3.T4

Physiology thyroid hormones in the plasma circulates as free amino acids only in the free form plays role for metabolism regulation under anterior pituitary thyrotropin thyroid-stimulating h. (TSH)  feedback

HyperthyroidismDescribethecausesDiscusstheprosand cons of thethreemajortreatment optionsKnow howto prepareapatientforoperationDescribeappropriatesurgicalproceduresKnowaboutearlyandlatepostoperative management

Hyperthyroidism ■ Describe the causes ■ Discuss the pros and cons of the three major treatment options ■ Know how to prepare a patient for operation ■ Describe appropriate surgical procedures ■ Know about early and late postoperative management