47073047-25-Thyroid-Parathyroid-and-Adrenal - Nina Ian John...

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S3 - Lec 10: Thyroid, Parathyroid, and Adrenals Nina Ian John “G” Rachel Mark Jocelle Junjun Gienah Jho Kath Aynz Je Glad Nickie Rico Titser Dadang Niňa Arlene Vivs Paul F. Rico F. Ren Mai Revs Mavis Jepay Yana Mayi Serge Hung Tope Agnes Bien THYROID GLAND HISTORY 1200’s AD - Advancements in goiter procedures included applying hot irons through the skin and slowly withdrawing them at right angles. The remaining mass of pedicled tissue is excised - Patients were tied to the table and held down to prevent unwanted movements - Most died from hemorrhage or sepsis 1646 AD - Willhelm Fabricus performed a thyroidectomy with standard surgical scalpels - The 10 y/o girl died, and he was imprisoned 1808 AD - Guillaume Dupuytrem performed a total thyroidectomy - The patient died postoperatively of ―shock‖ - Condemned for years as heroic and butchery 1850- French Academy of Medicine proscribed any thyroid surgery Mid-1800’s- only 106 documented thyroidectomies - Mortality 40%: exsanguination and sepsis 1842- Crawford Long uses ether anesthesia 1867- Lister describes antisepsis (lancet) 1874- Pean- invents hemostat 1883- Neuber- Cap and gown (asepsis) 1870’s-80’s- Billroth- merges a leader in thyroid surgery (Vienna) - Mortality-8% - Shows need for RLN preservation - Defines need for parathyroid preservation (von Eiselberg) - Emphasis on speed 1883- Kocher’s performs a retrospective review - 5000 career thyroidectomies - Mortality rates decreased 40% in 1850 (pre-Kocher and Billroth) 12.6% in 1870’s (Kocher begins practice) 0.2% in 1898 (end of Kocher’s career) - Many patients developed cretinism or myxedema - “cachexia strumipriva ‖ to describe this condition Kocher emerges as leader in thyroid surgery (Bern) - Mortality: 1889-2.4% 1900- 0.18% - Emphasis on meticulous technique In 1909 Kocher was awarded the Nobel Prize for medicine in recognition ―for his works on the physiology, pathology, and surgery of the thyroid gland.‖ THYROID DEVELOPMENT outpouching of the primitive foregut around the third week of gestation Foramen cecum - site of origin of thyroglossal duct between floor of bronchial arches 1 and 2. A depression of the posterior tongue Thyroglossal duct - endodermal down growth of thyroid epithelium from it. Developing tissue invades hypobronchial mesenchyme which gives capsule and septa Sites of thyroglossal cysts - (move up with protrusion of tongue), remnant thyroid tissues (lingual thyroid), fistulae, sinuses and pyramidal lobe Retrosternal thyroid - if developing process goes too far The ultimobronchial bodies (5th pouch) give ―C‖ cells Descent of the thyroid gland o Initial descent starts anterior to the pharyngeal gut o Thyroid still connected to the tongue via the thyroglossal duct o Later- tubular duct solidifies then obliterates entirely (during gestational weeks 7-10) o Foramen cecum- opening of the thyroglossal duct into the
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This note was uploaded on 05/16/2011 for the course NURSING 112 taught by Professor Brinley during the Spring '11 term at Pace.

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47073047-25-Thyroid-Parathyroid-and-Adrenal - Nina Ian John...

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