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external carotid
Lateral lobe
Isthmus
Inferior thyroid artery/vein
parathyroid gland
Esophagus
Trachea
Recurrent laryngeal n.
Arteries of thyroid gland and nerves of larynx
Superior thyroid a.
Branch of external carotid a.
Runs superficial and parallel
to the external branch of
superior laryngeal n. to reach
the upper pole of thyroid
gland
Gives off superior laryngeal
a. in company with internal
branch of superior laryngeal
n.
Superior laryngeal nerve
Internal branch which
pierces thyroid membrane
to innervates mucous
membrane of larynx above
fissure of glottis
External branch is fine n.,
which descends in company
with the superior thyroid a.
and supplies cricothyroid
Inferior thyroid artery
Branch of thyrocervical trunk off subclavian a.
Turns medially and downward, reaches the posterior
border of the thyroid gland and is closely related to the
recurrent laryngeal n.
Supplies inferior pole of thyroid gland
Synthesize 、 Store&Secrete
triidothyronine(T3 )
thyroxine (T4 )
Physiology Control
Hypothalamus:TRF
Pituitary:Thyrotropin(TSH)
adenylyl cyclase activity
Thyroid: T3 、 T4
Thyroid Hormones Function
Accelerate cellular oxygenization rate;
boost body's metabolism overall.
Promote protein,carbohydrate &fat
disintegrate
Promote body's growth and development
,histodifferentiation 。
Evaluation of the Thyroid
History-taking
Systematic mathod of palpating thyroid
size, contour, consistency, nodularity
fixation, displacement of trachea,
cervical lymph nodes.
The serum level of T3 、 T4
Radioactive iodine uptake(RAI)
Goiter
Etiology
Simple
Nodosity
Nodular Goiter
Cystic degeneration
Secondary hyperthyroidism
Canceration
Evaluation of Thyroid Nodules
and Goiters
(1)Sensitive TSH
(2)Percutaneous fine-needle biospy
Usually TSH-
Operate suppressive Repeat
operate treat and
observe
Operation Indication
Symptoms of pressure
Substernal extension
Cosmetic deformity
Secondary hyperthyroidism
Suspicion of cancer
Nodular Goiter
Specimen
After
operatoin
Goiter of Substernal extension
operating
Hyperthyroidism
Definition
Disorders
Systematic hypermetabolism
Types
Primarily hyperthyroidism ( Graves'disease )
Secondary
hyperthyroidism ( Pulmmer'disease )
Hyperactive adenoma
Iodine
Thyroiditis
Primary Hperthyroidism
Manifestation:Diffuse thyromegaly
Hypermetabolism
Clinical manifestation
Special examination
Clinical Manifestation
Nervousness,weight loss with increased appetite,heat
intolerance,increasing sweating,muscular weakness and
fatigue,increased bowel frequency,polyuria,menstrual
irregularities,infertility .
Goiter,tachycardia,aterial fibrillation,warm mosit
skin,thyroid thrill and bruit,cardiac flow
murmur,gynecomastia.
Eyes signs:stare,lid lag,exophthalmos.
TSH low or absent;TSI,iodine upake,T3 and T4
increased;T3 suppression test abnormal.
Special Examination
Basal metabolic rate
BMR = (PR+PP) - 111
T3 、 T4
Treament
Drugs treatment : PTU,Tapazol 50 %
Radioiodine therapy : 131I 90 %
Operation
Operation Indicatio
Secondary hyperthyroidism&hyperactive adenoma ;
Primary hyperthyroidism of midrange or above ;
Thyromegaly with symptoms of pressure
Recidivist after ATD or 131I post-treatment ;
Can not persist on medication
Surgical Contraindication
Teenagers
Lower symptom
Elderly patient or can not suffer operation 。
Preoperative preparation
General preoperative preparation
Operation
Postoperative Complications
Dyspneic respiration&choke
Recurrent laryngeal nerve (RLN) injure
superior laryngeal nerve ( SLN ) injure
Rheumatic contraction
Thyroid crisis
Rheumatic Contraction
Thyroid Neoplasm
Benign Tumor:adenoma
Secondary hyperthyroidism ( 20 %)
Canceration ( 10 %)
Fast freezing pathological section
Thyroid Carcinoma
Pathology
Papillary adenocarcinoma : 60-80 % ;age:30 ~
45 years female; 80 % :multinodular 。
Follicular adenocarcinoma : 10-
20 %, age:50years
Undifferentiated carcinoma : 1 %, age:70
years 。
Medullary carcinoma : 7 %
Papillary adenocarcinoma