Nat Aroicon 2007 Sujit 1.2
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This study evaluated the incidence of thyroid dysfunction in patients receiving radiotherapy (RT) or chemoradiotherapy (chemo-RT) for non-thyroid head and neck cancers. The study found that 20% of patients developed subclinical hypothyroidism, with most cases occurring within 6-12 months after treatment completion. Patients with hypopharyngeal tumors, T3 stage, N2 nodal involvement, or stage IV disease had a higher risk of developing subclinical hypothyroidism. While no patients showed clinical signs of hypothyroidism, many reported fatigue, indicating potential future overt hypothyroidism. Close monitoring of thyroid function was recommended.
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1. Preoperative evaluation by anesthesiologists has changed from being done on the day of surgery to well in advance, due to fewer patients being admitted before surgery and increased medical comorbidities among surgical patients.
2. Anesthesiologists now play a leading role in preoperative clinics to thoroughly evaluate high-risk patients, ensure medical optimization, and plan perioperative care in order to reduce risks and complications.
3. A comprehensive preoperative history and physical examination is important for determining patient-specific risks, developing an anesthetic plan, and obtaining informed consent.
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2) It presents with fever, tachycardia, arrhythmias, heart failure, tremors, and gastrointestinal issues like nausea and vomiting.
3) Treatment involves controlling adrenergic symptoms with beta blockers, treating the underlying thyroid abnormality with antithyroid drugs like PTU, and providing supportive care like fluids and electrolyte replacement.
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1. Preoperative evaluation by anesthesiologists has changed from being done on the day of surgery to well in advance, due to fewer patients being admitted before surgery and increased medical comorbidities among surgical patients.
2. Anesthesiologists now play a leading role in preoperative clinics to thoroughly evaluate high-risk patients, ensure medical optimization, and plan perioperative care in order to reduce risks and complications.
3. A comprehensive preoperative history and physical examination is important for determining patient-specific risks, developing an anesthetic plan, and obtaining informed consent.
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This document discusses the management of thyroid storm, a life-threatening condition characterized by a hypermetabolic state caused by underlying hyperthyroidism. Key points include:
- Thyroid storm is diagnosed clinically or using scoring tools like the Burch-Wartofsky Point Scale.
- Management aims to inhibit thyroid hormone synthesis/release and peripheral effects while reversing decompensation. This involves high-dose antithyroid drugs, beta blockers, corticosteroids, inorganic iodide, and treating any precipitating factors.
- Supportive treatments like IV fluids and nutrition are also important, along with considering urgent thyroidectomy or radioactive iodine in some cases. Patient education is crucial
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Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
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Pre anaesthetic assessment and preoperative fasting guidelines
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Chapter 2 pre_anesthetic_evaluation_presentation_1_for_students [autosaved]
Chapter 2 pre_anesthetic_evaluation_presentation_1_for_students [autosaved]
preoperative evaluation for residents of anesthesia part 1
preoperative evaluation for residents of anesthesia part 1
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This document discusses formative assessment and how it can be used to increase student learning. It provides examples of formative assessment strategies such as note taking, goal setting, rubric checks, and quick writes. These strategies provide feedback to students on their progress and next steps. The document also discusses the importance of feedback and how not all feedback is useful. Effective formative assessment answers three key questions: where is the student going? how is the student doing? and where to next? When used properly, formative assessment can reduce gaps between current and desired performance.
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Hypothyroidism after head & neck radiation A Complication & Implication
Hypothyroidism is a common complication of radiation therapy for head and neck cancers. The incidence of hypothyroidism after radiation ranges from 15-48%. Damage to the thyroid gland from radiation can result in both clinical and subclinical hypothyroidism. Early detection of hypothyroidism is important as treatment with levothyroxine replacement can prevent symptoms. Patients receiving radiation to the head and neck region should be monitored with TSH and free T4 tests before, during, and after treatment to screen for hypothyroidism.
Thyroid disorders
This document discusses 6 cases involving thyroid disorders. Case 1 involves a 56-year-old woman with fatigue, weight gain, and constipation diagnosed with Hashimoto's thyroiditis and hypothyroidism. Case 2 involves a 34-year-old woman with tremors, hot flushes, and weight loss diagnosed with silent lymphocytic thyroiditis. Case 3 involves a 40-year-old man with a thyroid nodule found on exam who should undergo fine-needle aspiration biopsy. Case 4 involves management of levothyroxine dosage for a pregnant woman with hypothyroidism. Case 5 involves a 75-year-old woman with fatigue and subclinical hypothyroidism who should repeat thyroid testing
Thyroid ppt [autosaved]
The document discusses thyroid disorders including hyperthyroidism, hypothyroidism, and thyroid storm and their implications for anesthesia such as increased sensitivity to drugs, risks of tachycardia and arrhythmias, and need for careful monitoring of cardiac and respiratory function. It provides guidance on preoperative preparation, intraoperative management, and postoperative care for patients with thyroid disorders undergoing surgery.
Approach to a patient with Anterior Neck mass.pptx
1) The document discusses the evaluation and management of different types of anterior neck masses, including thyroid nodules, thyroglossal cysts, carotid body tumors, cervical lymphadenitis, and branchial cysts.
2) It provides guidance on the questions to ask patients about neck lumps, associated symptoms, and examination findings. It also outlines the appropriate tests and workup depending on the suspected diagnosis.
3) The key points are that thyroid status must be determined, thyroid nodules in euthyroid patients should be referred to a surgeon for FNA, and different surgical procedures or treatments are used depending on the specific diagnosis.
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1. The patient has a history of thyroid cancer with metastases to the lungs and skull, and underwent total thyroidectomy and parathyroidectomy.
2. Treatment options for recurrent or metastatic thyroid cancer include radioactive iodine treatment, surgery, external beam radiation, and molecularly targeted therapies.
3. Molecular targeted therapies that show promise for thyroid cancer work by inhibiting pathways involved in cell signaling and angiogenesis, such as the MAPK and PI3K pathways, or by restoring radioiodine uptake.
Pharmacotherapy thyroid disorders
This document summarizes information about hypothyroidism and hyperthyroidism (thyrotoxicosis). It discusses the epidemiology, causes, clinical manifestations, investigations, treatment, and prevention of hypothyroidism. For hyperthyroidism/thyrotoxicosis, it covers the epidemiology, causes, clinical signs and symptoms, investigations, treatment options including anti-thyroid drugs, surgery and radioactive iodine, and considerations for treatment in pregnancy. It also provides details on myxedema coma, a rare but serious complication of severe untreated hypothyroidism.
management of Hyperthyroidism
The document provides an outline on the physiology and causes of hyperthyroidism, also known as thyrotoxicosis. It discusses the thyroid gland, thyroid hormone synthesis and regulation, clinical features of Graves' disease and toxic multinodular goiter, diagnosis of hyperthyroidism, and management approaches including antithyroid drugs, radioactive iodine therapy, surgery, and novel minimally invasive therapies. It also covers thyroid storm as a life-threatening emergency characterized by abrupt release of thyroid hormones.
Thyroid presentation
This document provides an overview of thyroid cancer, including the anatomy and physiology of the thyroid gland, epidemiology, risk factors, clinical presentation, diagnostic evaluation, staging, surgical management, and role of radioactive iodine treatment. Key points include that thyroid cancer is most commonly diagnosed through incidental finding of a thyroid nodule, surgical removal of the thyroid (total thyroidectomy) is the primary treatment, and radioactive iodine ablation may be used post-operatively depending on risk level. Prognostic factors include histologic classification and cancer stage at diagnosis.
Radioiodine dosage and modality koutsikos
There are many guidelines and recommendations suggesting ablation/therapy in Differentiated Thyroid Carcinoma. This presentation will be focused on the details of these recommendations and guidelines.
Furthermore, it will be discussed the use of recombinant human thyrotropin (rhTSH) prior to radioactive iodine remnant ablation for patients with differentiated thyroid cancer.
NON-GRAVES HYPERTHYROIDISM
This document discusses non-Graves' disease hyperthyroidism, including toxic adenomas, toxic multinodular goiter, hyperthyroid thyroid carcinoma, and iodine-induced hyperthyroidism. It provides details on the pathogenesis, clinical presentation, investigations, and management of each condition. The key information includes that toxic adenomas are caused by autonomous nodules with TSH receptor or Gsα mutations, radiotherapy or surgery are preferred treatments, and iodine-induced hyperthyroidism can occur in nodular goiters due to excessive iodine intake disrupting the Wolff-Chaikoff effect.
thyrotoxicosis in special situation the let.ppt
how thyroid hyperfunction affects children and elderly , when to suspect and how to treat Summary of clinical manifestations and how to peck and diagnose and methods of treatment
Thyroid
The document summarizes thyroid embryology, anatomy, physiology, and various thyroid diseases. It describes that the thyroid develops from the foregut and forms follicles that synthesize and secrete thyroid hormones. It regulates thyroid function tests and imaging used to evaluate thyroid diseases. It provides details on hyperthyroidism including Graves' disease and treatment options. It also discusses hypothyroidism and various causes of thyroiditis.
Thyroid
The document summarizes thyroid embryology, anatomy, physiology, and various thyroid diseases. It describes that the thyroid develops from the foregut and forms follicles that synthesize and secrete thyroid hormones. It regulates thyroid function tests and imaging used to evaluate thyroid diseases. It provides details on hyperthyroidism including Graves' disease and treatment options. It also discusses hypothyroidism and various causes of thyroiditis.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
Sub clinical thyroid dysfunction
This document discusses subclinical thyroid dysfunction, specifically subclinical hyperthyroidism and subclinical hypothyroidism. It defines the conditions, describes their causes and symptoms, and provides guidance on diagnosis and treatment. Subclinical hyperthyroidism occurs when TSH is low or undetectable but thyroid hormones are normal. Subclinical hypothyroidism occurs when TSH is elevated and thyroid hormones are normal. The document recommends treatment for those with subclinical hyperthyroidism over 65 years old with TSH <0.1 mU/L and for subclinical hypothyroidism with TSH >10 mU/L. It also suggests monitoring or possible treatment for those with mildly abnormal TSH levels based on individual
Targeted therapy in thyroid cancer
1) Targeted kinase inhibitors such as sorafenib show promise in treating radioactive iodine refractory thyroid cancer, with sorafenib demonstrating a partial response rate of 36% and clinical benefit in 82% of patients in one study.
2) Management of radioactive iodine refractory thyroid cancer involves local therapies when possible and enrollment in clinical trials of small molecule tyrosine kinase inhibitors like sorafenib, which target pathways important in thyroid cancer signaling and growth.
3) Guidelines recommend targeted kinase inhibitors as first-line treatment for radioactive iodine refractory thyroid cancer based on their improved efficacy over chemotherapy and ability to potentially prolong progression-free and overall survival.
MANAGEMENT OF GLIOMAS
This document provides an overview of the management of gliomas. It discusses the general management and specific management of low grade and high grade gliomas.
For low grade gliomas, the main treatment options are observation, surgery, radiation, and chemotherapy. Surgery aims for maximal safe resection followed by radiation therapy. Chemotherapy with PCV may provide a survival benefit for high risk patients based on one trial, but requires further study.
For high grade gliomas, prognostic factors like age, performance status, extent of resection, and molecular markers are discussed. Treatment involves maximal safe surgery followed by concurrent chemoradiation and adjuvant chemotherapy with temozolomide, which has become the standard of care based on clinical trials
TREATMENT THYROTOXICOSIS
This document discusses the treatment of thyrotoxicosis. The main goals of treatment are to decrease hyperthyroid symptoms and establish a euthyroid state. The main treatment modalities are antithyroid drugs, radiotherapy, and surgery. Antithyroid drugs like methimazole and propylthiouracil work by inhibiting thyroid hormone production. Radioactive iodine treatment involves administering radioactive iodine which is taken up by the thyroid gland to destroy thyroid tissue. Surgery involves removing part or all of the thyroid gland. Selection of treatment depends on factors like severity of symptoms, comorbidities, risks of each treatment, and patient preferences. Long term follow up is needed to monitor thyroid hormone levels and watch
Hashimoto`s thyroiditis.pptx
Hashimoto's thyroiditis is a chronic autoimmune thyroid disorder characterized by the presence of goiter and hypothyroidism. It is caused by antibodies attacking the thyroid and impairing its function. The main symptoms are those of hypothyroidism like fatigue and weight gain. Treatment involves lifelong thyroid hormone replacement therapy via levothyroxine to manage hypothyroidism. Surgery may be indicated for large goiters causing obstruction, suspicious nodules, symptoms refractory to medication, or cosmetic reasons. Fine needle aspiration is important to screen for thyroid cancer.
Thyroid Benign Slides
This document provides a summary of benign thyroid diseases and their history, physiology, evaluation, and treatment. It discusses various thyroid conditions including goiter, hypothyroidism, hyperthyroidism, thyroiditis, and toxic nodular goiter. For each condition, it outlines the etiology, pathogenesis, diagnosis, and standard treatment approaches. It also reviews the history of thyroid surgery and advances in the understanding and management of thyroid function.
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RT in Ca Esophagus
1) Radiation therapy alone is not very effective for treating esophageal cancer and results in less than 10% 5-year survival. Concurrent chemoradiation provides better outcomes with 30% 5-year survival.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Nat Aroicon 2007 Sujit 1.2
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- 13. 100.0 80.0 20.0 % 50 40 10 Count TOTAL 2 2 0 Count Others 2 2 0 Count Unknown primary 8 2 6 Count Hypopharynx 10 10 0 Count Larynx 16 14 2 Count Oro-pharyn 12 10 2 Count Oral cavity No Yes Total HYPOTHYROID PRIMARY SITE 100.0 80.0 20.0 % 50 40 10 Count Total 2 2 0 Count TX 6 6 0 Count T4 18 12 6 Count T3 22 18 4 Count T2 2 2 0 Count T0 No Yes Total HYPOTHYROID T STAGE
- 14. 100.0 80.0 20.0 % 50 40 10 Count Total 6 4 2 Count N3 8 4 4 Count N2 26 22 4 Count N1 10 10 0 Count N0 No Yes Total HYPOTHYROID N STAGE 100.0 80.0 20.0 % 50 40 10 Count Total 16 10 6 Count STAGE 4 22 18 4 Count STAGE 3 12 12 0 Count STAGE 2 No Yes Total HYPOTHYROID STAGE GROUPING