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					 The   thyroid gland in human beings is a
    brownish-red organ having two lobes
    connected by an isthmus; it normally weighs
    about 28 g (about 1 oz) and consists of
    cuboidal epithelial cells arranged to form
    small sacs known as vesicles or follicles.
   Each follicle is formed by a single layer of
    epithelial (follicular) cells and is filled with a
    secretory substance called colloid
 two  thyroid hormones thyroxine, also called
  tetraiodothyronine (T4), and triiodothyronine
  (T3). These hormones are composed of the
  amino acid tyrosine, containing four and
  three iodine atoms, respectively.
 Thyroid hormone increase the metabolism
  and protein synthesis in nearly all of the
  tissues of the body
A  clinical syndrome that results when tissues
  are exposed to high levels of circulating
  thyroid hormones
 Common Cause:
    Grave’s Disease: Diffuse goiter and exophthalmos
 Other Causes: multinodular goiter, adenoma
 of the thyroid and ingestion of excessive
 thyroid hormone
 Thyroid      Storm
    Extreme and life threatening form of
     thyroidtoxicosis
    Occurs in undiagnosed cases and inadequate
     treatment
    Signs
        Tachycardia, congestive heart failure, angina
        Irritability agitation, delirium
    Mortality Rate is high
 Exophthalmos,   lid lag, decreased blinking,
  presence thyroid mass
 Restlessness, irritability, anxious, insomnia,
  hyperactivity, emotional lability
 Increased cardiac output, tachycardia,
  palpitation, rapid pounding pulse during
  sleep
 Diarrhea. Increased appetite
 Increased muscle tone and reflexes with
  tremors and twitching
 Heat intolerance
 Increased sweating, thin and silky hair and
  skin
 Weight loss
 Increased level of T4 and T3
 Removalof all or a part of the thyroid gland
 Recommended on the following procedures:
    Thyroid cancer
    Goiter
    Hyperthyroidism (unresponsive to antithyroid
     meds)
          is performed on a thyroid gland
 operation
 depends upon 2 major factors
    thyroid disease present
    anatomy of the thyroid gland itself
 Transverse  collar incision is made in a
  natural skin crease about 1 inch (2cm)
  above the clavicle.
 The cervical fascia is incise vertically in the
  midline
 Induction of general anesthesia via
  inhalation and intravenous
 The surgeon must be careful of the recurrent
  laryngeal nerves which are very close to the
  back side of the thyroid and are responsible
  for movement of the vocal cords
 The surgeon must also be careful to identify
  the parathyroid glands so their blood supply
  can be maintained.
 Subtotal
  thyroidectomy-
  removal of
  approximately 5/6
  of the thyroid gland
  (hyperthyroidism
  and goiter
 Total
  thyroidectomy-
  Excision of both
  lobes plus the
  isthmus. (Thyroid
  cancer)
 Bleeding
 Airway  obstruction caused by bleeding
 Permanent hoarse or weak voice due to
  nerve damage
 Damage to the four small glands located
  behind your thyroid (parathyroid glands),
  which can lead to hypoparathyroidism,
  resulting in abnormally low calcium levels in
  your blood and bones and an increased
  amount of phosphorus in your blood.
 Promote      Preoperative Euthyroid test
    Review test of thyroid function are within normal
     limits
    Rested and relax
    Weight and nutritional status are normal
    Cardiac problems are under control
        Normal pulse
        No dangerous dsyrhythmias
 Preoperative teaching about medication, and
  compliance with treatment
 Patient are prescribed with anti thyroid drugs
 Saturated solution of Potassium iodide may
  administered to reduce vascularity of the gland
 Scarf or necklace will most likely helps in covering
  the site
 Assess   for signs of respiratory distress
    In an event intubation and tracheostomy set is
     prepared
 Assess   for signs of hypocalemia
    Paresthesia of the mouth, toes, fingers and
     generalized muscle twitching
    Chvostek signs- facial muscle spasm elicited by
     tapping the facial nerve near the parathyroid
     gland
    Trousseau sign- carpal spasm elicited by pressure applied
     to nerves of the upper arm
    Tetany- Carpopedal spasm (spasm flexion of wrist and
     ankle joints)
 Intravenous  calcium gluconate or calcium chloride
  is used to treat hypocalemia
 Positioning- Semi fowlers; neck slightly flexed to
  avoid strain on the sutures and observation for
  bleeding
Chvostek signs-   Trousseau sign-

				
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Description: Procedure of thyroidectomy