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THYROID CANCER

PREDISPOSING FACTOR: Age Gender PRECIPITATING FACTORS: Previous exposure to radiation treatment in the neck area. Prolonged secretion of thyroid stimulating hormone (TSH) (radiation or hereditary.)

Underlying pathophysiology Papillary cancer is usually multifocal and bilateral Metastasizes slowly into regional nodes of the neck, mediastinum, lungs, and other distant. Least virulent form of thyroid cancer. Follicular cancer is less common but is more likely to recur, metastasize to the regional lymph nodes, and spread to the blood vessels into the bones, liver and lungs. Medullary (solid) carcinoma orginates in the parafolicular cells derived from the last bronchial pouch. Anaplastic carcinoma ( giant, squamoid, and spindle cell subtypes) resists radiation and is almost never curable by resection.

Pathophysiologic Changes Painless, hard nodule or swelling in the thyroid gland, or palpable lymph nodes with thyroid enlargement (reflecting Hoarseness, dysphagia, and dyspnea or constant wheezing from increased tumor growth and pressure on surrounding structures. Hyperthyroidism due to excess thyroid hormone production from tumor. Hypothyroidism secondary to destruction of thyroid gland by tumor.

COMPLICATIONS
Distant metastasis

Dysphagia

Stridor

Hormone alterations

TREATMEN T
Radioactive iodine therapy to treat metastasis

Total or subtotal thyroidectomy with modified node dissection

Total thyroidectomy and radial neck excicion for medullary, anaplastic cancers.

Therapy with external radiation to treat inoperable cancer

Adjunctive thyroid suppression with exogenous thyroid hormones to suppress TSH production.

Chemotherapy for symptomatic, widespread metastasis.

NURSING CONSIDERATIONS
Preoperative

If the patient will undergone surgery, tell the patient to expect hoarseness (but not voice loss) lasting for several days after the surgery.

Post

Keep the patient in semi fowlers position after he regains consciousness, make sure his head is neither hyperextended nor flexed, to avoid pressure.

Monitor vital signs, and then check the patients dressing, neck, and back for bleeding.

Check serum calcium level every 12 hours because hypocalcemia may develop if the parathyroid glands have been removed.

Watch for and report other complication: hemorrhage and shock (elevated pulse rate and hypotension), tetany, thyroid storm, respiratory obstruction.

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