外科-甲状腺疾病PPT.ppt

THYROID ADENOMAS ? found in the woman 40 yr ? typically asymptomatic ? discover incidentally by patient or physician ? round or elliptic shape ? smooth surface ? harder than adjacent thyroid tissue ? tenderness occur as intracystic hemorrhage Clinical feature THYROID ADENOMAS hard to distinguish from nodular goiter clinically ? thyroid adenomas found outside epidemic area of simple goiter ? nodular goiter tending multiple nodules adenoma remains solitary Clinical feature THYROID ADENOMAS ? US scanning found single nodule Clinical feature THYROID ADENOMAS ? 131I scanning normal Cold nodule Hot nodule Clinical feature THYROID ADENOMAS Surgical management because ? 20% tending hyperthyroidism ?10% develop malignancy ? partial resection ? follow biopsy to identify carcinoma Treatment THYROID ADENOMAS Treatment a heterogeneous group of tumors show considerable variability in ? biologic behavior ? histologic appearance ? response to therapy approximately 1% of all malignancies Simple Goiter Treatment After surgical procedure prescribe thyroid hormone e.g. thyroxine ? to inhibit TSH release ? stop stimulate thyroid ? prevent recurrence ? Thyroid disease aspect ? History of manage thyroid disease ? Thyroid gross anatomy ? Physiology of thyroid ? Simple goiter ? Hyperthyroidism ? Thyroid adenoma ? Thyroid carcinoma ? Primary hyperparathyroidism Topics Hyperthyroidism caused by ? high levels of thyroid hormone ? loss normal feedback controlling of thyroid h. Types of hyperthyroidism in surgery book ? diffuse toxic goiter ? secondary toxic multinodular goiter ? toxic adenoma Hyperthyroidism ? irritability ? weight loss ? heat intolerance ? emotional instability ? physical findings of goiter ? exophthalmos other eye signs Clinical manifestation Hyperthyroidism Laboratory examinations standard to confirm diagnosis measuring circulating thyroid hormone concentration ? total thyroxin (TT4)