Thyrotoxicosis is a clinical syndrome caused by high levels of circulating thyroid hormones, with primary causes including Graves' disease and toxic nodular goiter, leading to symptoms of weight loss, fatigue, heat intolerance, and emotional changes. Diagnosis is based on examination findings of a goiter, tachycardia, and eye changes like exophthalmos, with treatment options including antithyroid drugs, radioactive iodine, or surgery to remove the overactive thyroid tissue.
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
Myxoedema coma Pharmacotherapeutic viewPranatiChavan
Myxedema coma is an extreme complication of hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. The term myxedema is often used interchangeably with hypothyroidism and myxedema coma. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who are hypothyroid. Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection.
It include anatomy , physiology of thyroid gland. Hyperthroidism and its causes, risk factors, diagnosis, medical and nursing management, complication.
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
Myxoedema coma Pharmacotherapeutic viewPranatiChavan
Myxedema coma is an extreme complication of hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. The term myxedema is often used interchangeably with hypothyroidism and myxedema coma. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who are hypothyroid. Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection.
It include anatomy , physiology of thyroid gland. Hyperthroidism and its causes, risk factors, diagnosis, medical and nursing management, complication.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Thyrotoxicosis
“clinical syndrome that results when
tissues are exposed to high levels of
circulating thyroid hormones.”
Hyperthyroidism Other causes like excessive
ingestion of thyroxine, release
of hormone in ovarian tumors
5. DIFFUSE TOXIC
GOITRE
Grave’s disease (S/S & diffuse vascular
goitre appears simultaneously)
Primary thyrotoxicosis
8 times more common in females
Hyperthyroidism more severe than secondary
Cardiac failure rare
6. FEATURES: FEMALE
Female with strong family predisposition
(50%)
Extra thyroidal manifestation
Middle or young age (30-50 yr)
Autoimmune disorder (evidence
:demonstration of TSH R auto – antibodies in
the circulation)
human Leukocyte antigen(HLA) and T-
lymphocyte may contribute
Enlargement of gland is diffuse.
•Pretibial myxoedema
• Proximal myopathy
• Acropachy
• Ophthalmoplegia
11. Site : Swelling in the lower part of the front of the neck.
Size : slight to moderate enlargement.
Shape : symmetrical.
Surface: smooth.
Skin overlying: is warm.
Special character : moves up & down with
deglutition.
Consistency : soft or firm
Edge: well defined.
Pulsations & thrills : are detected usually
at the upper poles
12. CNS signs
Insomnia
Tremors of tongue and outstretched
hands
Agitation
Exaggerated reflexes
13. Cutaneous Changes
Moist warm extremities
Profuse sweating & flushed face
Falling of hairs
Clubbing of fingers & toes
Soft and brittle nails
14. Pretibial myxoedema
B/L, non pitting edema, ± a/w
clubbing
aka thyrotoxic dermopathy
Seen in thyrotoxicosis pt. treated
with surgery or antithyroid drugs
Always a/w exophthalmos
Cause : deposition of
myxomatous tissue(GAG’s)
mainly in pretibial region
Skin – dry coarse and swelling
due to obliterated lymphatics by
mucin
15. CVS
More in elderly
PULSE
Rate : Sleeping pulse up to 100 – 120/ min
Character : water - hammer character
Rhythm: cardiac arrythmias are
superimposed on sinus tachycardia as
disease progresses.
16. Stages of development of
cardiac arrythmias in
thyrotoxicosis
Multiple extrasystoles
Paroxymal atrial tachycardia
Paroxysmal atrial fibrillation
Persistent atrial fibrillation
(non responsive to digoxin)
17. (V) Eye manifestations :
A. Exophthatmos ( > 50 % of cases ) :
TYPES :
a)Apparent ( mild = false) exophthalmos :
widening of the palpebral fissure due to spasm of
Muller's muscle.
18. b)True exophthalmos :
actual protrusion of the eyeballs.
It is an autoimmune disease
Infiltration of retro bulbar tissue with
inflammatory cells & fluids with
varying degree of spasm of upper
eyelid as LPS is partly innervated by
symapthetic fibres
Probably due to cross- reaction of thyroid antigen & eye (Schwartz )
C.T showing infiltration of
Retro bulbar spaces
True exophthalmos
With widdened palpebral
apperture and
clearly seen sclera
19.
20. Classification of eye changes in Graves’ disease
Class Definition
0 No signs or symptoms.
1 Only signs, no symptoms. (Signs limited to
upperlid retraction, stare, lid lag.)
2 Soft tissue involvement (s/s).
3 Proptosis
4 Extraocular muscle involvement(diplopia)
5 Corneal involvement.
6 Sight loss (optic nerve involvement).
Severe cases are marked by pappiloedema and corneal
ulceration referred to as malignant exophthalmos
21. Spasm and retraction usually disappears
when hyperthyroidism is controlled – B
adrenergic drugs
Sleeping propped up and lateral
tarsorrhaphy help protect the eye
Prednisolone – improvement has been
reported….intraorbital not preferred.
When the eye is in danger…orbital
decompression reqd
22. Toxic nodular goitre
Simple, nodular goitre
present for a long time
before the hyperthyroidism
Middle aged or elderly
Eye symptoms rare
Usually nodules are
inactive and interthyroid
tissue is overactive
If 1 or more nodules are
active – hyperthyroidism is
due to autonomous tissue
23. Toxic nodule
Solitary overactive nodule
Autonomous
Hypertrophy not due to
TSH-Rab
Normal surrounding
thyroid tissue is inactive
due to suppressed TSH
secretion bcoz of high ,
level of circulating
hormones
24.
25. TREATMENT
NON SPECIFIC – Rest and Sedation.
SPECIFIC – Medical intervention
Surgical intervention
Radioiodine
26. ANTI – THYROID DRUGS
Carbimazole, Propyluracil, Methimazole
B – adrenergic blockers – proranolol,
nadolol
Iodides – dec vascularity of the gland
only used as immediate preoperative
measure
Drugs help maintain euthyroid state for a
long time in hope of spontaneous
remission
Block
Cvs
effects
27. Regime
Start with 10mg carbimazole- 3 or 4 times a
day …. Latent interval – 2 weeks
When pt. becomes euthyroid, decrease the
dose to 5mg- 2 to 3 times a day for 6 to 24
months
Alternative regime- BLOCK AND
REPLACEMENT THERAPY
Inhibit all T3 T4 production with high dose and
then give maintainence dose of 0.1 – 0.15mg
of thyroxine daily
decreased risk of iatrogenic thyroid
insufficiency and less follow up required
28. Adv : no surgery and no use of
radioactive
Disadv: prolonged t/t and failure rate
about 50%.
aplastic anemia and agranulocytosis
Poor prognosis: large gland size,
severity of disease nad TSH-Rab levels
29. RADIO-IODINE
Destroys thyroid cells
Reduces mass of thyroid tissue below a
critical level
Slow response.. substantial
improvement expected in 8 – 12 wks.. If
not repeat dose
Higher dose – thyroid failure in 6mnths
Lower dose result in insufficiency
Due to sublethal damage to cells not
damaged by t/t
30. SURGERY
Indicated in- severe diffuse toxic goitre
- toxic nodular goitre with overactive
internodular tissue
-toxic nodule
Cures by reducing overactive mass
Subtotal thyroidectomy- long term followup
Total or near total thyroidectomy- immediate
thyroid failure with life long thyroxine
replacement… SIMPLIFIES FOLLOW UP
31. Adv: Goitre is removed, cure is rapid and
cure rate is high if surgery has been
adequate
Disadv: recurrence in 5% cases
risk of permanent hypothyroidism
nerve injury
young women – cosmetic issues
32. Structure
Each lobe
Pear shaped
2 *1*1 inches
Its apex lies at
Level of oblique line
Of thyroid cartilage
& base reach 5th.
Or 6th. Tracheal
ring
Isthmus lies on
2nd. ,3rd. ,4th ,
Tracheal rings
Pyramidal lobe
It is connected to hyoid bone
By fibrous band ( levator glandulae )
thyroid
2 capsules :
*true C.T. capsule around gland
*false outer capsule from
pretracheal fascia
Pretracheal fascia
33. 1- arterial :
Blood supply
• superior thyroid artery
• Branch from E.C.A..
– Inferior thyroid artery
– Branch from thyrocervical trunk
– Which is branch of 1st. Part of subclavian
Others
Thyroid artery from aorta ( may be absent )
Accessory tracheal & esophageal braches
34. 2- venous :
Superior thyroid vein
drain to I.J.V.
middle thyroid vein
drain to I.J.V.
inferior thyroid veins
drain to left innominate vein
The middle thyroid vein
Is the shortest soit is the
1st To be ligated
35. Superior laryngeal nerve
internal laryngeal nerve
Sensory to m.m of
Larynx above vocal cords
external laryngeal nerve
Motor to cricotyroid
Muscle
Injury causes voice weakness
It is closely related
To
Superior thyroid artery
Right R.L.N.
Turns around 1st. Part
Of subclavian artery
Left R.L.N.
Turns around arch of
aorta
Both supply all Intrinsic muscles
Of larynx except (cricothyroid )
& m.m below vocal cords
Injury causes vocal cord paralysis
36. Surgical anatomy
From superficial to deep:
Skin
Platysma (a muscle in superficial fascia
of neck)
Investing layer of deep cervical fascia
Pre-tracheal layer of deep cervical
fascia
Strap muscles of neck (thin flat muscles)
37. Preoperative preparation
Make patient euthyroid
CARBIMAZOLE regime (8-12wks)
Alternate: B adrenergic blocking drugs
abolish clinical manifest. of toxic state
propranolol(40mgTDS) or nadolol(160mg OD)
rapid response.. Operation can be arranged
within few days
continue therapy for 7 days postoperatively
40. Technique
GA with endotracheal intubation
Pt. is supine with table tilted at 15° at the
head end to reduce venous
engorgement (reverse trendelenburg)
Sand bag placed transversely under the
shoulder
Neck extended
Apply tension to skin, platysma and
strap msls for easy dissection.
41. Curved skin incision made midway
between notch of thyroid cartilage and
suprasternal notch
Flaps of skin, s/c, platysma raised
upwards to superior thyroid notch and
downwards to suprasternal notch
42. Exposing the gland
Investing fascia divided in the midline
Strap msls divided only if large area to be
exposed
Sternohyoid msl is mobilised off the thyroid
lobe taking care to stay close to msl and
outside capsule
Pretracheal fascia opened
Gland is exposed
43. Dealing with vessels
Arteries before veins (to prevent venous
engorgement)
Vessels clamped, divided and ligated
Superior thyroid artery ligated close to the
upper pole of the gland.
This is to prevent damage to external
laryngeal nerve.
44. Inferior thyroid artery is similarly dealt with
faraway from the lower pole of the gland
This is to safeguard recurrent laryngeal
nerve.
They are not routinely ligated to preserve
parathyroid function
Then superior, middle and inferior thyroid
veins are dealt with in a similar manner.
46. Parathyroid glands
Identified by careful inspection
If inadvertently or unavoidbly excised or
devasularised
Should be fragmented and auto-
transplanted immediately within
sternoclenomastoid muscle
47. Absolute hemostasis secured by ligation
of individual vessels and by suture of
thyroid remnants to tracheal fascia
Pretracheal msls and cervical fascia are
sutured and wound closed
48. Complications
Hemorrhage
Respiratory obstruction
Recurrent laryngeal nerve paralysis-Hoarseness
of voice
Hypocalcemic tetany (due to accidental removal
of parathyroid glands during total thyroidectomy)
Wound infection: This may manifest after 48
hours of surgery
Thyroid insufficiency
Thyrotoxic crisis
Hypertrophic / Keloid scar
Stitch granuloma
49. Post operative care
Transient hypocalcemia – oral Ca+2
maybe necessary….if severe then 10ml
IV Ca+2 gluconate 10% given
Screen parathyroid insufficiency –
serum Ca+2 measured 4-6wks after
operation
Recurrent thyrotoxicosis common –
lifelong follow up