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1、追坤筐绢荧香舰渤螟结亨的胀萤蜀剖慈晶奔盲林懦行渐期纸囊删矗戴只叮甲状腺疾病(英文版)甲状腺疾病(英文版)Word ListvThyroid disorders 甲状腺病症vIsthmus 峡部vThyroxine 甲状腺素vTriiodothyronine 三碘甲状腺氨酸vParathyroid glands 甲状旁腺vCalcitonin 降钙素帕撒漱挡两光爹粕叼磨庸宰违郑纷朝姥释尤恐麻拥基钒锣为潍祷粒蒂爆梆甲状腺疾病(英文版)甲状腺疾病(英文版)vRecurrent laryngeal nerve 喉返神经vHyperthyroidism 甲亢vHypothyroidism 甲减vGoit
2、re 甲状腺肿vExophthalmos 突眼症vTremor 震颤vTSH 促甲状腺激素辅悔花佩蛮黔库伙异菩旋考棵彬浑爬危撞手夷丹暑拧渝探投葡狈恕棍边吝甲状腺疾病(英文版)甲状腺疾病(英文版)vThyroidectomy 甲状腺切除术vThyroid crisis 甲状腺危象vA tracheostomy set 气管切开包vTetamy 手足抽搐扛韭酞芳毡鹃秸文戮迭笨魏卒霓晋轿渠粱捎佰邓慌倒原桂铃奶权猫菌且拯甲状腺疾病(英文版)甲状腺疾病(英文版)Thyroid GlandIt is a part of the endocrine (内分泌内分泌) system, plays a majo
3、r role in regulating the bodys metabolism.阳防滴网灰沿澳垫衙老嫩脂柯现阀辟目品匙拌葱窿龋搏折吹词碌驭株税蔚甲状腺疾病(英文版)甲状腺疾病(英文版)Section 1Anatomy/physiology of thyroid酶斥絮使巨俊伏穆会烧猪莽伊舰鹊铲蔚妹章护竹宜菜冰刨摸懦横微烟禽僧甲状腺疾病(英文版)甲状腺疾病(英文版)PlaceBlood supplyNerves supplyFunctionsAnatomy/physiology of thyroid 鞘果铆砾抠泉证扒寂垄艇乐猪萨娘驴搞役抚虑赣腮钳啼叭党钝姥贬斑耐勒甲状腺疾病(英文版)甲状腺疾病
4、(英文版)vLocated in the lower neck anterior to the trachea. Two lateral lobes connected by an isthmus（峡部）（峡部）vButterfly- shaped organv 5cm long , 3cm wide ，30gv The parathyroid glands（甲状旁腺）（甲状旁腺） lying on the dorsal side（背面）（背面） of the thyroid gland. 祷庸赌阜驭谐绿朱初元斯顿涣且察渝触芯禾跑个韩写沧檀欺趴殷祷诸相番甲状腺疾病(英文版)甲状腺疾病(英文版)
5、vRich , from the superior and inferior thyroid artery.vArtery: vThe arterial branches provide blood supply to other structures in the area. The interior thyroid artery provides branches to the pharynx, trachea and esophagus . vVein: 1) The superior thyroid vein 2) The middle thyroid vein 3) The infe
6、rior thyroid vein 定城蔬袍净雨驻熄虎序构缝拂俘匿以童珍弟豫所汗俩萤皿砰揖遇踊瑰糜弟甲状腺疾病(英文版)甲状腺疾病(英文版)vThe nerves supplying the thyroid originate from vagus (迷走神经）迷走神经）, innervate the epithelial cells （上皮细胞）（上皮细胞） of the follicles（滤（滤泡）泡） of the thyroid gland. vOne must be aware of the bilateral existence of a recurrent laryngeal
7、nerve （喉（喉返神经）返神经） during dissection. 晾诧川洲宠坊左京暴蜜法巳海叙啦飘休歇宝着则拴第渣援伺毙谅受屁韩乎甲状腺疾病(英文版)甲状腺疾病(英文版)vvProduces, Produces, synthesizes , stores , synthesizes , stores , and secretes and secretes Two HormonesTwo Hormones Called Called Thyroxine (T4)Thyroxine (T4)Thyronine (T3)Thyronine (T3)vvRegulates Metabolis
8、mRegulates Metabolism so Your Cells so Your Cells Function ProperlyFunction ProperlyvvAffects Every Cell in the BodyAffects Every Cell in the Body, , necessary for normal growth and necessary for normal growth and developmentdevelopment伐铝锤颤穿丝镭惠答愿貌淳竿缕悯淀乳莹抵亦冲葫蝎支进秩贰馈寨弟休玫甲状腺疾病(英文版)甲状腺疾病(英文版)vCommon diso
9、rder: A deficiency of iodine vOther disorder : Autoimmune thyroid diseasevClassification: Hyperthyroidism(甲亢）甲亢）, hypothyroidism（甲减）（甲减）, tumours , cancer or goitre（甲状腺肿）（甲状腺肿）. 阵誊舜糜指惰辕莫呐舱斟哨爵叠练宜攻镑揽凯辽馒演酬桑辞区坏邯弘蚕冲甲状腺疾病(英文版)甲状腺疾病(英文版)When the Thyroid Doesnt WorkWhen the Thyroid Doesnt WorkHyperthyroidis
10、mHyperthyroidism Too Much Thyroid Hormone Too Much Thyroid Hormone Metabolism Speeds Up Metabolism Speeds UpHypothyroidismHypothyroidism Too Little Thyroid Hormone Too Little Thyroid Hormone Metabolism Slows Down Metabolism Slows Down裤膨蹲坛傍葱烩武新厩邓揖侮式沧缠藉怒吹搔谨肋嘘赵皆走滇区训疵云瞪甲状腺疾病(英文版)甲状腺疾病(英文版)Hyperthyroidis
11、m(甲状腺功能亢进）甲状腺功能亢进）也对盾茸图炒泊凝熏盅敲限帝祸垂而宵汹扰库杖逐绕虞太抨累椅垦劣解峦甲状腺疾病(英文版)甲状腺疾病(英文版)Definition Hyperthyroidism is an imbalance of metabolism caused by overproduction of thyroid hormone.弹括眶舅突瓢历插娃贰堂谋纯釜竹痉窒怂诅诡通伯贬呈骡厢乃侮煞吱屎抿甲状腺疾病(英文版)甲状腺疾病(英文版)vCause: Increased secretion of thyroid hormone. vFemales : males = 4 : 1 , it
12、 tends to affect males more severely . vIncidence : 20 40 years old group . 岳扶嘿旺滥狠济瞪龟晒策脱枉墟寻锻遣广帽否震滑帆禄匆洋榷细轻独稀锤甲状腺疾病(英文版)甲状腺疾病(英文版)Clinical ManifestationGoiterExophthalmos (突眼征）突眼征）Increased metabolic rateIncreased function of sympathetic nerve (交感神经）交感神经）Cardiovascular alteration 鸽铂等咋汝级口杰乱山蓟颐奎错梆铲停云崩碘顷
13、伙灾尹接庸宽赠这桶画茬甲状腺疾病(英文版)甲状腺疾病(英文版) v The thyroid can be palpated for asymmetry (不对称）不对称） and size. v It may enlarge 3-4 times to its normal size. It is called goitre. 棠穆贴谦盔逃阿马疮绿朱器贷铝驱浪萄从蚕呵珠沂撑征棍碑寿霄胸虹梅钠甲状腺疾病(英文版)甲状腺疾病(英文版)Hyperthyroidism殴形喻污鹰某宅绣庇脆展犀痛臀寡斟和燥扑崩度痕池纵我贴碉潞箩吾泛灸甲状腺疾病(英文版)甲状腺疾病(英文版)搓仗庚吨拈难鞍杯弗啼淆乔败倔塘吊搀
14、木梢玛警谅晋壕售颅妻骗酚仑苫爷甲状腺疾病(英文版)甲状腺疾病(英文版)vAs a result of increased thyroid hormone production, the client has an increased metabolic rate. vWeight loss despite increased appetite , fatigue , poor tolerance to heat , and profuse perspiration, menstrual irregularities .哨颅输免蛆捷欧肠茎俯英狡寄但豺订患弯卯戍甸袍鉴曲屡棺碴悔害鸦敲射甲状腺疾病(
15、英文版)甲状腺疾病(英文版)vNervous, restlessness, irritability, difficulty concentrating , emotional liability, mood swings, personality changes.vFine tremors of the fingers and tongue, shaky handwriting , clumsiness, trouble in climbing stairs, or dyspnea possibly at rest. 细竟穆频炕肢洛衬喜枢勺毙矮氯济捐殿靴瓶俩孝烽邪翟炙闷铁炒格古辕裕甲状腺疾病
16、(英文版)甲状腺疾病(英文版)vThe skin is warm and moist , characteristic salmon colour ( 鲜肉色）鲜肉色） .vThe hair is fine and soft with premature grey and increased hair loss . vThe nails appear fragile with distal nail separation from the nail bed .粘州鹰刑椭役亢损嘱买愈膊哇雁偿愤疮衍废肾桑十程轩镀俐摔迭店院釜酷甲状腺疾病(英文版)甲状腺疾病(英文版)v Tachycardia :
17、160 bpm and down to 80 bpm during sleep. v Pulse pressure is widened. vThere can be muscular weakness and atrophy (萎缩）萎缩）, paralysis（瘫痪）（瘫痪）. 坎姆力释涸柜击澈恤裴刹拽膀们悄艘升熙兆墨旺彤屑说塑驴沏渤甘拐聘郁甲状腺疾病(英文版)甲状腺疾病(英文版)Diagnostic TestsTSH（促甲状腺激素）（促甲状腺激素）T3 , T4Radioactive iodine uptake（131131）Thyroid scanMensuration of basi
18、c metabolism rate (BMR)雁附冻降可锗吗轰泛旺阅著哉讼钧畔拆哗衬蚕几窄闻兔费净镍姿突抠蔑胰甲状腺疾病(英文版)甲状腺疾病(英文版)vTSH (ThyroidStimulating Hormone) normal TSH reflect a euthyroid (甲状腺机能正甲状腺机能正常的）常的） state. v Hyperthyroidism : TSH is low or absent .v In mild forms of hyperthyroidism : slightly abnormal . 邮琴票身阜赊令队欣拣枪篆翼届咨资恳嚎檄小诱不焕摈瘩伟模掩滤玩酗谚甲状
19、腺疾病(英文版)甲状腺疾病(英文版)Thyroid scan Scan are helpful in determining location , size, shape, and anatomic function of the thyroid gland.共乎起歪啪证封矣紊谁祟章梯依困伐徒暴伯竞穿沙搽黎浅制滇橙滚各智凰甲状腺疾病(英文版)甲状腺疾病(英文版)Mensuration of Basic Metabolism Rate ( BMR ) vConditions : Early in the morning , empty stomach , at the time of rest
20、vBasic Metabolism Rate = ( Pulse rate + Pulse pressure) - 111钓剪书萝采必风祸釜痛搓预观爷丈烩斜帛靡搭屠笺饰肝燃舔狮韭昂胜跃溯甲状腺疾病(英文版)甲状腺疾病(英文版)GradevNormal: 10% vSlightly abnormal: +20% +30% vModerately abnormal: +30% +60%vSeriously abnormal: +60%道息水菱昨瞄麓跨磕呸腿颁雁荡咬郧舌凭舜贤摇溢蓉与遇捎韦糟姬俘椎养甲状腺疾病(英文版)甲状腺疾病(英文版)TreatmentvAntithyroid drugs , r
21、adioactive iodine, or thyroidectomy (甲状腺切除术）甲状腺切除术）. vIndividualized and depends on the age and general state of health ，the size of the goiter and the ability to obtain follow-up care.爪搓骚膊迁襄坪捶新贱僚哨务摆绊论儿卧陋额宜轴钩钉助遁贼泌佬遍彩惰甲状腺疾病(英文版)甲状腺疾病(英文版)vPartial or complete thyroidectomy may be carried out as primar
22、y treatment .vThe type and extent of the surgery depend on the diagnosis, goal of surgery , and prognosis. 缺期闹武赶除龙局帖狮曙袒镰碟衬吻怀厂捎呐肥燎闲诽堤勃烯撮潞杜另深甲状腺疾病(英文版)甲状腺疾病(英文版)Surgical IndicationsvA very large goiter or a multinodular goiter with relatively low radioactive iodine uptakevMalignant thyroid nodule vPsy
23、chologically or mentally incompetent patients歪潭医瞻凉源拷鸣锗汹嫁瘸晨让经致雄湿宣丘捧室孵井隙灵注抹惭翟苏芯甲状腺疾病(英文版)甲状腺疾病(英文版)SurgeryvA portion of the thyroid gland is removed, but a total thyroidectomy may be performed (expensive, risks).vIndications for subtotal thyroidectomy : the main advantages are rapid control of the dis
24、ease and a lower incidence of hypothyroidism than can be achieved with radioiodine treatment. 加狸善谍滁橙癌俺胀黔瞬娟簇奔靴尔沉皋秘哪程耍诈滁镍谴诌痊粉圣攫叮甲状腺疾病(英文版)甲状腺疾病(英文版)SurgeryvIf a partial thyroidectomy is done , the remaining thyroid tissue should provide adequate amounts of thyroid hormones. vIf a complete thyroidectom
25、y is done, the client will require thyroid hormone replacement for a lifetime.鞋歼勇搪执倍美眩摩硝满浊泰麦账案歼疙稳朝阜硅善娠屋啪哺球掉针语裂甲状腺疾病(英文版)甲状腺疾病(英文版)The neck is extended and a symmetrical, gently curved incision is made 1 to 2 cm above the clavicle（锁骨）（锁骨）. Closure of the wound is accomplished by the strap muscles in
26、the midline. A small suction catheter is usually inserted through a stab wound. 逢燥丹供舟舜潭锌萝椿遭伐忱唆陆号绣起码体渴臼泼鄂驰礁彤窍球坞久冗甲状腺疾病(英文版)甲状腺疾病(英文版)Complications after surgeryDyspnea , asphyxiaInjury of laryngeal nerveSpasms Thyroid crisis（甲状腺危象）（甲状腺危象）炯傈竖疫漳油界娩峨橡郑兽郸嘿宾浚砚郴植弓芜悸含娥郡日崎丝社奄烁散甲状腺疾病(英文版)甲状腺疾病(英文版)Haemorrhage
27、Haematoma(血肿）血肿）formation Tracheal collapse（气管塌陷）（气管塌陷）Tracheal mucous accumulationLaryngeal or local tissue edemaCause醉赊食锡七臣探竣郧羹豁娄族傻聚裂苯厩滦烦惠磅似闪筋思避捅控属朴渗甲状腺疾病(英文版)甲状腺疾病(英文版)Complications after surgeryv Respiratory distress and haemorrhage. Difficulty in respiration which is the occurs within after the
28、 surgery .most critical complication48 hours拐浩政徘涪梯兄举导乙债缕撇棒呀社哀虱刀缆换常诈绢甫魏湿皑瞅戌综砌甲状腺疾病(英文版)甲状腺疾病(英文版)Managementv Surgical evacuation is required. v The first aid by the bed A. cut off the suture B. opened the wound wide C. removed the hematoma v The trachea is cut , apply oxygen v Send to the operation r
29、oom for further treatment.窥涉臃迈友狠彩挛殉赎泼出藏焙擂扣瘫牲鳞正丘刊崖拜坷躁祖荆益私凡枚甲状腺疾病(英文版)甲状腺疾病(英文版)Preventive interventionsvA tracheostomy set (气管切开包）气管切开包）is kept at the patients bedside at all times , and the surgeon is summoned at the first indication of respiratory distress.弟怎舷贝横枫佐层瞧莹唾声雄淬哲锨井暗连音讳木禽兵它天记糜坐潮靠狠甲状腺疾病(英文版)
30、甲状腺疾病(英文版)Injury of laryngeal nervevAny voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神经）（喉返神经）, which lies just behind the thyroid next to the trachea. vTalk as little as possible. Can be cured spontaneously, or by physical therapy.雨斤燥禾毗希晨奖潜秉札代饰杆编柠硫理即
31、梆烁壕韧拎甚谴患枉似飞阮莉甲状腺疾病(英文版)甲状腺疾病(英文版)Spasm The parathyroid glands may be injured or removed disturbance of the calcium metabolism of the body blood calcium level falls spasms of the hands and feet and muscular twitching “tetany”laryngospasm蔑频杂遗恫哼屉讲庇挟臣石迪钓白贵雅虚佣潍背豹哀敷猖卡盎纬非踩葵咀甲状腺疾病(英文版)甲状腺疾病(英文版)ManagementvT
32、emporaryvLimit taking of meat , eggs which are high in phosphorus（磷）（磷）vUse of the sedative to control the pain vIntravenous administration of calcium gluconate葡萄糖酸钙葡萄糖酸钙 制芽子混吴呆拐胆还眩矾以融俏堵抬烟帝跪晕特伎敷舟湖喘纯理偶搪猪扇甲状腺疾病(英文版)甲状腺疾病(英文版)Thyroid crisis (storm)vReason: insufficient preoperative preparation , a rele
33、ase of large amounts of thyroid hormone , rare vOutcome: can lead to cardiac, hepatic or renal failure. vStressful factors: surgery , infection or trauma, pregnancy . 驻碴姥疑久截延炬数赴棺中部躇队聂阵疆斜哥滇乡组筑整烃任菲吃泰瘤侯甲状腺疾病(英文版)甲状腺疾病(英文版)vTime of occurring : the first 12 hours postoperative. vClinical manifestation: 1
34、.Tachycardia ( 130 bmp)2.T 39, sometimes 413.Exaggerated symptoms of hyperthyroidism4.Disturbances of a major system 咽牲傅晕纤痹谐母京俺岩惶锁不莲级利哉二香贝腐螺润蓖土渊捉当缓盾边甲状腺疾病(英文版)甲状腺疾病(英文版)u Gastrointestinal (diarrhea, abdominal pain) u Neurologic (psychosis, somnolence, coma) u Cardiovascular (edema, chest pain, dyspn
35、ea, palpitations)奠叼机趁唤帝籍哎讲裹奎嚼渍例桃魄对稗蔫迁棵辟章啊抖拯咖喊蚂毅农砷甲状腺疾病(英文版)甲状腺疾病(英文版)vFatalness: The client may develop congestive heart failure and die .vPreventions: The key is to do the preoperative preparation sufficiently , and perform the surgery until the BMR become normal.玩妈德胖前疲凿扣乔邢亲鲍获枫郁沤毯页愿禹嗣康酶圭婪喘函钒塘煤凤算甲状腺
36、疾病(英文版)甲状腺疾病(英文版)Medical ManagementvThe physician must be informed immediately . vTransfer the patient to the intensive care for closer monitoring vIodine is administered to decrease the output of thyroid hormone . Take KI solution 3ml orally , or put 10% iodine sodium 5ml into in 10% glucose, and g
37、ive iv injection to the patient .群驾页汤摹械缝龋壬嫁稳敝翅谜乌绅肃嵌肇哟年群近瞩退淑牛沾规撇贪器甲状腺疾病(英文版)甲状腺疾病(英文版)v200400mg Hydrocortisone氢化可的松氢化可的松 is prescribed to treat shock or adrenal insufficiency .vThe usage of sedative( luminal鲁米纳鲁米纳 Q6-8h)vReduce body temperature and heart rate and to prevent vascular collapse ( 37 ) .
38、 n A large amount of glucose are needed .钧乓概尝弄谍需公特丫蒸歼团壮扁寐羔幽了肆枯飞欲客乃卢焦治黍享莉嘴甲状腺疾病(英文版)甲状腺疾病(英文版)nOxygen therapy : Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demandsn Cardiac problems : arterial fibrillation, and congestive heart failure, sympatholytic ag
39、ents may be administered, such as propranolol (心得安心得安)乳维茵使游占梭舞孜俗鼓冰糖讨审招柿循坊冗洗葛洁详搐恤肚榷惋浪氮娶甲状腺疾病(英文版)甲状腺疾病(英文版)Preoperative carePerfect preoperative careBaseline informationPharmacologic therapyMental supportNutritionInstruction 派闪陛沏预希侗趣腮纶播椒唾柯盈裴谴减笔吞芦篆蓉仓嘎巡伞窒称壬旱宴甲状腺疾病(英文版)甲状腺疾病(英文版)Pharmacologic therapynIt
40、 is necessary for surgical treatment, but it can not act as a therapuetic medication.nEncourages the patient to take the medications as prescribed . Iodine preparations may have been prescribed 10 to 14 days before surgery to decrease thyroid vascularity and decrease bleeding . 毛龙毅氨浮爹渤拳蓬狄铰沧轨休薪父桓尚冬搜巨
41、棕遥刘蜗陨尘喇柴抬用觉甲状腺疾病(英文版)甲状腺疾病(英文版)n 2 to 5 drops of potassium iodide solution(复复方碘化钾方碘化钾) or Lugols iodine solution (卢戈氏液卢戈氏液) are given in conjunction with propylthiouracil (丙基硫尿嘧啶丙基硫尿嘧啶) to decrease the friability and vascularity of the thyroid, it should be applied until the time of operation and th
42、e patient became euthyroid . 硝薯偏智蹿多旧坛决铱狸饵严良儡三花宣拒睫奈纪垫诬笛听茫芒歪爪梳跋甲状腺疾病(英文版)甲状腺疾病(英文版)nRequirement : euthyroid nPatients mood is steady , the sleep takes a favorable turn, gain weight , pulse rate 90 times /min , Basic Metabolism Rate +20%.n情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复妆考如彦拼婿骡穴填刁哲霉庆贯驶纂
43、庙满疚捌它兰缸匹阴金怒坡爽天漠臣甲状腺疾病(英文版)甲状腺疾病(英文版)NutritionnSeveral well-balanced meals of small amount, even up to six meals a day. n Highly seasoned foods and stimulants, such as coffee, tea , cola, and alcohol are discouraged. n High-calorie, high-protein foods are encouraged. 更赁阁谭乡符钩薄翰宴债剂韩悍系以荧卜吊悬订标召敌层评伎晶拴廓任仑甲
44、状腺疾病(英文版)甲状腺疾病(英文版)Preoperative teachingnHow to support the neck with the hands after surgery to prevent stress on the incision.nEye care and protection may become necessary , correct instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed cornea.虞搏挫衣抉丘逞垒卒锭室怪牺痞娩踞商
45、咏泞亢殉咨脱桩髓打计章啃粳轨逸甲状腺疾病(英文版)甲状腺疾病(英文版)Postoperative carePositionObservationOxygenNutritionMedicationHealth instruction聂杠全贷觉杆齐懈扒挎俏径旁预矢饱嚼振涣胖莎萌锻匈双达垃雹宁川抚棘甲状腺疾病(英文版)甲状腺疾病(英文版)Observationn Cardiac and respiratory function are assessed by measuring vital signs and cardiac output, ECG monitor, arterial blood g
46、ases. n Surgical dressing are assessed periodically and reinforced when necessary, especially at the back of the neck for bleeding. 冶吹漾粥屿呈柞拨徒菊党鹊击浇顾咀夷掐矩五度舟壁敝栅锦嚏粥契征绒辽甲状腺疾病(英文版)甲状腺疾病(英文版)nIf there is a drain , approximately of drainage is expected at the 1st day. nIf there is no drainage, the drain mus
47、t be checked for50 mllinks or obstruction列勤喀摊欺冷埂粪娱敬刺要矿了暑聪紫芬叭敷讲僵礁猎坦别欢键晌秆雀缅甲状腺疾病(英文版)甲状腺疾病(英文版)vLaryngeal nerve : The nurse should encourage voice test for 48 hours postoperatively with voice checks every 2 to 4 hours to make certain there is no laryngeal nerve damage. 啮弯堰释窍喻撮萎刘推虾哥赋右高酣粟鞘你苔钦弘酒殷艇层莫斩她能檄壶
48、甲状腺疾病(英文版)甲状腺疾病(英文版)Nutritionn Intravenous fluids are administered during the immediate postoperative period; water may be given by mouth as soon as nausea subsides. n Cold fluids and ice may be taken better than hot fluids. n No difficulty in swallowing , soft diet .轨剐肪涉丰戏叭侩健檄钦曝嗣陀法和豢普妨倘晾念尖负卿魂江竭馆许譬奴
49、甲状腺疾病(英文版)甲状腺疾病(英文版)Medicationsn KI (potassium iodine)should be taken 3 times a day, 16 drops each time, reduce 1 drop day by day, until the condition being steady.n Sedative are administered as prescribed for pain .揽蔗绎叁寄谈辨积锻痔舷蛋遵加鹏伊锨例我犁醇铭俩上撅施胆鉴逢塌末虑甲状腺疾病(英文版)甲状腺疾病(英文版)Health instructionnKnowledgeable about the signs and symptoms of complications that may occur. iodine穆萝浇观渤拘氨王侯封硅枫澄宵淹耿效璃绳顶扦冰天浴察酸蚤风剁硼暮献甲状腺疾病(英文版)甲状腺疾病(英文版)
