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??? ???? ?????? ?????? |
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ANAESTHESIA & ENDOCRINE DISEASES Dr.Mushtaq Ahmad |
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ENDOCRINE SYSTEM |
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THYROID GLAND 2 lobes connected by isthmus
Location: ant neck at C5-T1, overlays 2nd – 4th tracheal rings |
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VASCULAR ANATOMY SUPERIOR THYROID ARTERY
INFERIOR THYROID ARTERY
THYROID IMA ARTERY
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VASCULAR ANATOMY VENOUS:
3 PAIRS OF VEINS:
STV – IJV
MTV - IJV
ITV -BCV |
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RELATIONS WITH NERVES Superior thyroid artery---superior laryngeal nerve
Inf. Thyroid artery---RLN |
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Follicles: the Functional Units of the Thyroid Gland Follicles Are the Sites Where Key Thyroid Elements Function:
Thyroglobulin (Tg)
Tyrosine
Iodine
Thyroxine (T4)
Triiodotyrosine (T3)
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Biosynthesis of T4 and T3 |
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TSH ATD TSH TSH |
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The Thyroid Hormones |
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Production of T4 and T3 |
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Carriers for Circulating Thyroid Hormones |
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FREE HORMONE CONCEPT |
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Hypothalamic-Pituitary-Thyroid Negative Feedback Mechanism TSH secretion is
Pulsatile---
Maximum at
midnight |
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Thyroid-Stimulating Hormone (TSH) |
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Thyroid Hormone Action |
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Growth and Development |
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THYROID HORMONES & (CNS) |
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Thyroid hormone influences cardiovascular hemodynamics Thyroid hormone
Mediated Thermogenesis
(Peripheral Tissues) Release Metabolic Endproducts Local
Vasodilitation Decreased Systemic Vascular Resistance Decreased Diastolic Blood Pressure Cardiac Chronotropy and Inotropy Increased Cardiac Output &
excitation Elevated Blood Volume T3
HYPERDYNAMIC
CIRCULATION |
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THYROID HORMONES & (CNS) |
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Thyroid Hormones Stimulate Metabolism-Calorigenic effect |
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METABOLIC EFFECTS |
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THYROID FUNCTION TESTS |
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THYROID DISEASES |
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GENERAL ANAESTHETIC
CONSIDERATIONS |
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HYPERTHYROIDISM |
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HYPERTHYROIDISM CAUSES |
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COMMON SYMPTOMS |
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MNG AND GRAVES Huge Toxic MNG Diffuse Graves Thyroid |
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Proptosis Lid lag THYROID OPHTHALMOPATHY |
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OPHTHALMOPATHY IN GRAVES Occular muscle palsy |
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OPHTHALMOPATHY IN GRAVES Periorbital edema and chemosis |
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SEVERE EXOPHTHALMOS |
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Clubbing and
Osteoarthropathy THYROID ACROPATHY |
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Typical Thyroid Hormone Levels in Thyroid Disease
TSH T4 T3
Hypothyroidism High Low Low
Hyperthyroidism Low High High |
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TREATMENT OPTIONS |
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SYMPTOM RELIEF |
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Anti Thyroid Drugs (ATD) |
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How long to give ATD ? |
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Radio Active Iodine (RAI Rx.) |
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SURGICAL TREATMENT |
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ANAESTHETIC CONSIDERARIONS |
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INTRAOPERATIVE |
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RECURRENT LARYNGEAL NERVE PALSY |
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HYPOPARATHYROIDISM |
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HYPOTHYROIDISM |
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HYPOTHYROIDISM |
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HYPOTHYROIDISM: TYPES |
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PRIMARY HYPOTHYROIDISM CAUSES |
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CLINICAL MANIFESTATIONS |
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ANAESTHTIC COSIDERATION |
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INTRAOPERATIVE |
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Slide 79 :
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INSULIN ANABOLIC
LACK
CATABOLISM
NEG NITROGEN BALANCE
RATE 0F SECRETION—
PLASMA GL LEVEL
50 U/DAY |
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INSULIN AFFECTS MANY ORGANS:
IT STIMULATES SKELETAL MUSCLE FIBERS.
IT STIMULATES LIVER CELLS.
IT ACTS ON FAT CELLS
IT INHIBITS PRODUCTION OF CERTAIN ENZYME.
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Slide 81 :
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DIAGNOSIS OF DM |
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