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محاضرات الغدة ومرض الغدة.pptx

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• ‫الغدد‬ ‫إحدى‬ ‫هي‬ ‫الدرقية‬ ‫الغدة‬ ‫الجس‬ ‫في‬ ‫األساسية‬ ‫الصماء‬ ‫م‬ . • ‫الجزء‬ ‫أمام‬ ‫بالعنق‬ ‫وتوجد‬ ‫الهوائي‬ ‫القصبة‬ ‫من‬ ‫العلوي‬ ‫ة‬ . • ‫جانبيها‬ ‫على‬ ‫يعر‬ ‫ما‬ ‫أسفل‬ ‫ف‬ ‫آدم‬ ‫بتفاحة‬ . • ‫حرف‬ ‫شكل‬ ‫وتأخذ‬ H • ‫فصين‬ ‫من‬ ‫وتتكون‬ ‫متصلين‬ .
• ‫هي‬ ‫ال‬ ‫غدة‬ ‫ال‬ ‫مسئولة‬ ‫عن‬ ‫تكوين‬ ‫از‬‫ر‬‫وإف‬ ‫مجموعة‬ ‫من‬ ‫الهرمونات‬ ( ‫المواد‬ ) ‫التي‬ ‫يحتاجها‬ ‫الجسم‬ ‫للنمو‬ ‫الجسدي‬ ‫والعقلي‬ ‫وا‬ ‫همها‬ ‫هرمون‬ ‫كسين‬‫و‬‫الثير‬ .  , ‫الجسم‬ ‫يحتاج‬ ‫هذا‬ ‫الهرمون‬ ‫لتنظيم‬ ‫عمليات‬ ‫التمثيل‬ ‫ال‬ ‫غذائي‬ ‫بالخاليا‬ .  ‫يحتاجه‬ ‫الجسم‬ ‫ة‬‫ر‬‫بصو‬ ‫ثفة‬‫مك‬ ‫كمحفز‬ ‫نمو‬ ‫فى‬ ‫ات‬‫ر‬‫فت‬ ‫الن‬ ‫مو‬ ‫السريع‬ ‫كالفترة‬ ‫الجنينية‬ ‫وفترة‬ ‫حديث‬ ‫ي‬  ‫الوالدة‬ ‫والطفولة‬ .
‫تبدا‬ ‫الغدة‬ ‫الدرقية‬ ‫في‬ ‫التكون‬ ‫من‬ ‫سبوع‬‫اال‬ ‫السابع‬ ‫من‬ ‫عمر‬ ‫الج‬ ‫نين‬ . • ‫تبدا‬ ‫في‬ ‫العمل‬ ‫از‬‫ر‬‫وإف‬ ‫الهرمونات‬ ‫من‬ ‫سبوع‬‫اال‬ ‫الثاني‬ ‫عش‬ ‫ر‬
• ‫يتم‬ ‫بالتنسيق‬ ‫بين‬ ‫كل‬ ‫من‬ : • ‫الغدة‬ ‫تحت‬ ‫المهاد‬ ‫الغدة‬ ‫النخامية‬ ‫والغدة‬ ‫الدرقية‬ . • ‫يشكل‬ ‫هذا‬ ‫الثالوث‬ ‫الجهاز‬ ‫المنظم‬ ‫لتكوين‬ ‫الهرمون‬ ‫ون‬ ‫سبته‬ ‫في‬ ‫الدم‬ . • ‫يتحدد‬ ‫از‬‫ر‬‫إف‬ ‫كسين‬‫و‬‫الثير‬ ‫طبقا‬ ‫الحتياجات‬ ‫الخالي‬ ‫ا‬ .
• ‫عند‬ ‫وصول‬ ‫الهرمون‬ ‫المحفز‬ TSH ‫للغدة‬ ‫الدرقية‬ ... • ‫تبدا‬ ‫في‬ ‫تصنيع‬ ‫هرمون‬ ‫كسين‬‫و‬‫الثير‬ ( T3,T4 ) .... • ‫عن‬ ‫طريق‬ : – ‫اصطياد‬ ‫عنصر‬ ‫اليود‬ ‫من‬ ‫الدم‬ ‫ودمجه‬ ‫مع‬ ‫بعض‬ ‫حماض‬‫اال‬ ‫مي‬‫اال‬ ‫نية‬ ‫داخل‬ ‫الغدة‬ . – ‫ثم‬ ‫يدفع‬ ‫جزء‬ ‫من‬ ‫الهرمون‬ ‫المتكون‬ ‫إلى‬ ‫الدم‬ ‫مباشرة‬ ‫والجزء‬ ‫ا‬ ‫خر‬ ‫آ‬ ‫ال‬ ‫ن‬‫يخز‬ ‫في‬ ‫ن‬‫مخاز‬ ‫خاصة‬ ‫بالغدة‬ ‫ليصبح‬ ‫تحت‬ ‫الطلب‬ ‫عند‬ ‫ا‬ ‫لحاجة‬ .
• ‫يقوم‬ ( ‫تحت‬ ‫المهاد‬ ) ‫بإصدار‬ ‫ات‬‫ر‬‫إشا‬ • ‫للغدة‬ ‫النخامية‬ ‫كي‬ ‫ز‬‫تفر‬ ‫الهرمون‬ • ‫المحفز‬ ‫للغدة‬ ‫الدرقية‬ ( TSH ) .
• ‫يصدر‬ ‫الهيبوثاالمس‬ ‫ته‬‫ر‬‫إشا‬ ‫للغدة‬ ‫النخامية‬ • ‫بالتوقف‬ ‫عن‬ ‫از‬‫ر‬‫إف‬ ‫المزيد‬ ‫من‬ ‫الهرمون‬ ‫المحفز‬ . • ‫وبالتالي‬ ‫تتوقف‬ ‫الغدة‬ ‫عن‬ ‫التصنيع‬ ‫وعن‬ ‫دفع‬ • ‫المزيد‬ ‫من‬ ‫الهرمون‬ ‫للدم‬ .
• ‫مصنع‬‫مدير‬ ( ‫والهيبوثاالمس‬ ‫النخامية‬‫الغدة‬ ) . ‫يصد‬ ‫ر‬ ‫بالتصنيع‬ ‫ا‬‫ر‬‫م‬‫ا‬ ( ‫المحفز‬ ‫الهرمون‬ ) . ‫للمصنع‬ ( ‫الدرقية‬ ‫الغدة‬ ) . • ‫ي‬ ‫قوم‬ ‫ا‬ ‫لمصنع‬ ‫ال‬‫المواد‬‫باحتجاز‬ ‫خام‬ ‫المنتج‬‫وتصنيع‬ ( ‫هرمون‬ ‫كسي‬‫و‬‫الثير‬ ‫ن‬ ) ‫للمستهلك‬‫يده‬‫ر‬‫وتو‬ ( ‫الخاليا‬ ) . • ‫وي‬ ‫المزيد‬‫تصنيع‬‫عن‬‫المصنع‬‫يتوقف‬‫اإلنتاج‬‫ايد‬‫ز‬‫يت‬‫عندما‬ ‫للتخزين‬‫لجا‬ ‫وهكذا‬ .
• ‫مرض‬ ‫خلقي‬ ‫ناتج‬ ‫عن‬ ‫نقص‬ ‫تكوين‬ ‫از‬‫ر‬‫وإف‬ ‫هرمون‬ ‫و‬‫الثير‬ ‫كسين‬ ‫من‬ ‫الغدة‬ ‫الدرقية‬ . • ‫يعتبر‬ ‫هذا‬ ‫المرض‬ ‫من‬ ‫ثر‬‫ك‬‫ا‬ ‫اض‬‫ر‬‫م‬‫اال‬ ‫المسببة‬ ‫لإلعاقة‬ ‫ش‬ ‫يوعا‬ ‫فنسبته‬ ‫اوح‬‫ر‬‫تت‬ ‫بين‬ 1 ‫لكل‬ 3500 ‫طفل‬ – 1 ‫لكل‬ 4000 ‫طفل‬ . • ‫في‬ ‫مصر‬ ‫تصل‬ ‫نسبة‬ ‫االصابة‬ ‫الى‬ 1 ‫لكل‬ 2250 ‫طفل‬
.1 ‫ر‬‫قصو‬ ‫الغدة‬ ‫الدرقية‬ ‫ولى‬‫اال‬ : – ‫سباب‬‫ا‬ ‫متعلقة‬ ‫بنمو‬ ‫ر‬‫وتطو‬ ‫الغدة‬ ‫الدرقية‬ : • ‫عدم‬ ‫وجود‬ ‫الغدة‬ . • ‫ر‬‫ضمو‬ ‫الغدة‬ . • ‫وجود‬ ‫الغدة‬ ‫في‬ ‫مكان‬ ‫غير‬ ‫المكان‬ ‫الطبيعي‬ . • ‫تشكل‬ ‫هذه‬ ‫سباب‬‫اال‬ 90 % ‫من‬ ‫الحاالت‬ ‫وتكون‬ ‫غير‬ ‫مصحوبة‬ ‫بتضخم‬ ‫ف‬ ‫ي‬ ‫الغدة‬ ‫الدرقية‬ – ‫سباب‬‫ا‬ ‫متعلقة‬ ‫بوجود‬ ‫عيوب‬ ‫خلقية‬ ‫في‬ ‫تصنيع‬ ‫هرمون‬ ‫ال‬ ‫غدة‬ ‫الدرقية‬ – ‫سباب‬‫ا‬ ‫متعلقة‬ ‫بانعدام‬ ‫حساسية‬ ‫الغدة‬ ‫الدرقية‬ ‫للهرمونات‬ ‫المحفزة‬
.1 ‫ر‬‫قصو‬ ‫الغدة‬ ‫الدرقية‬ ‫ولى‬‫اال‬ : – ‫الغذاء‬‫في‬ ‫اليود‬‫نقص‬ . – ‫للغدة‬ ‫المثبطة‬ ‫العقاقير‬‫لبعض‬ ‫م‬‫اال‬‫تعاطى‬ . – ‫الحمل‬‫ثناء‬‫ا‬ ‫شعة‬‫لال‬ ‫م‬‫اال‬‫تعرض‬ . ‫حوالي‬‫الحاالت‬ ‫هذه‬‫وتقارب‬ 10 % ‫في‬‫بتضخم‬‫مصحوبة‬‫وتكون‬ ‫الدرقية‬ ‫الغدة‬ .
.2 ‫ر‬‫قصو‬ ‫الغدة‬ ‫الدرقية‬ ‫الثانوي‬ : ‫نسبته‬ : ( 1 ‫لكل‬ 200.000 ) ‫يشمل‬ ‫عدم‬ ‫قدرة‬ ‫الغدة‬ ‫النخامية‬ ‫و‬‫ا‬ ‫اتحت‬ ‫المهاد‬ ‫على‬ ‫از‬‫ر‬‫إف‬ ‫الهرمونات‬ ‫المحفزة‬ .
• ‫اض‬‫ر‬‫ع‬‫ا‬ ‫مبكرة‬ ‫غير‬ ‫محددة‬ : • ‫وتظهر‬ ‫في‬ 10 % ‫من‬ ‫طفال‬‫اال‬ ‫المصابين‬ . • ‫ال‬ ‫تخرج‬ ‫عن‬ ‫كونها‬ ‫اض‬‫ر‬‫ع‬‫ا‬ ‫عامة‬ ‫تشترك‬ ‫فيها‬ ‫مع‬ ‫اض‬‫ر‬‫م‬‫ا‬ ‫ى‬‫خر‬‫ا‬ ‫وليست‬ ‫كافية‬ ‫للتشخيص‬ ‫مثل‬ : • ‫قلة‬ ‫البكاء‬ ‫وطول‬ ‫فترة‬ ‫النوم‬ . • ‫ومتاعب‬ ‫في‬ ‫الرضاعة‬ ( ‫نوبات‬ ‫شرقان‬ ‫وعدم‬ ‫اإلقبال‬ ‫على‬ ‫الرض‬ ‫اعة‬ ) ‫متاعب‬ ‫في‬ ‫التنفس‬ ( ‫انسداد‬ ‫نف‬‫اال‬ ‫وتنفس‬ ‫مصحوب‬ ‫صو‬‫با‬ ‫ات‬ ) ‫قلة‬ ‫نشاط‬ ‫الطفل‬ ‫واإلمساك‬ ‫ار‬‫ر‬‫واصف‬ ‫الجلد‬ . • ‫وبعض‬ ‫طفال‬‫اال‬ ‫يعانون‬ ‫من‬ ‫فتق‬ ‫ى‬‫سر‬ ‫وانتفاخ‬ ‫في‬ ‫البطن‬ ‫وتضخم‬ ‫باللسان‬ ‫وانتفاخ‬ ‫بالجفون‬ ‫نيميا‬‫وا‬ .
‫مضاعفات‬ ‫خرة‬‫متا‬ : • ‫خر‬‫تا‬ ‫في‬ ‫النمو‬ ‫وقصر‬ ‫القامة‬ . • ‫صمم‬ ‫و‬ ‫تخلف‬ ‫عقلي‬ ‫وضعف‬ ‫القدرة‬ ‫على‬ • ‫التعلم‬ . • ‫وتتوقف‬ ‫درجة‬ ‫التخلف‬ ‫العقلي‬ ‫على‬ • ‫سرعة‬ ‫تشاف‬‫اك‬ ‫المرض‬ ‫وعالجه‬
• ‫ثبتت‬‫ا‬ ‫اسات‬‫ر‬‫الد‬ ‫ان‬ ‫فاعلية‬ ‫العالج‬ ‫ثر‬‫تتا‬ ‫بسرعة‬ ‫اك‬ ‫تشاف‬ ‫وعالج‬ ‫المرض‬ : ‫حيث‬ ‫ن‬‫ا‬ ‫نسبة‬ ‫من‬ ‫يصل‬ ‫معدل‬ ‫ذكاؤه‬ 85 ‫ثر‬‫ك‬‫فا‬ ‫بعد‬ ‫العالج‬ ‫هى‬ : • 87 % ‫إذا‬ ‫تم‬ ‫تشاف‬‫اك‬ ‫وعالج‬ ‫المرض‬ ‫قبل‬ ‫سن‬ 3 ‫ر‬‫شهو‬ • 19 % ‫إذا‬ ‫تم‬ ‫تشاف‬‫اك‬ ‫وعالج‬ ‫المرض‬ ‫فى‬ ‫سن‬ 3 - 6 ‫ر‬‫شهو‬ • ‫صفر‬ % ‫إذا‬ ‫تم‬ ‫تشاف‬‫اك‬ ‫وعالج‬ ‫المرض‬ ‫بعد‬ ‫سن‬ 7 ‫ر‬‫شهو‬
• ‫يعتبر‬ ‫التحليل‬ ‫سلبيا‬ ‫و‬ ‫الطفل‬ ‫طبيعي‬ ‫إذا‬ ‫كان‬ ‫الهرم‬ ‫ون‬ ‫المحفز‬ ‫في‬ ‫المعدل‬ ‫الطبيعي‬ ‫لنفس‬ ‫العمر‬ ‫وهو‬ ‫اقل‬ ‫من‬ 13 ‫و‬‫مايكر‬ ‫يونيت‬ / ‫ملم‬ ‫فإذا‬ ‫كان‬ ‫مستوى‬ ‫الهرمون‬ ‫المحفز‬ ‫للغدة‬ ‫الدرقية‬ TSH ‫في‬ ‫العينة‬ ‫قية‬‫ر‬‫الو‬ ‫من‬ 13 – ‫اقل‬ ‫من‬ 25 ‫و‬‫مايكر‬ ‫يونيت‬ / ‫ملم‬ ( ‫اشتباه‬ ‫اصاب‬ ‫ه‬ ‫في‬ ‫العينة‬ ‫قية‬‫ر‬‫الو‬ ‫االولى‬ ) ‫و‬‫ا‬ ‫كانت‬ ‫العينة‬ ‫غير‬ ‫صالحة‬ , ‫ت‬ ‫طلب‬ ‫عينة‬ ‫قية‬‫ر‬‫و‬ ‫ة‬‫ر‬‫مكر‬ ‫ما‬‫ا‬ ‫إذا‬ ‫كان‬ ‫مستوى‬ ‫الهرمون‬ ‫المحفز‬ ‫للغدة‬ ‫الد‬ ‫رقية‬ TSH ‫في‬ ‫العينة‬ ‫قية‬‫ر‬‫الو‬ 25 ‫و‬‫مايكر‬ ‫يونيت‬ / ‫ملم‬ ‫ثر‬‫ك‬‫فا‬ ‫فتطل‬ ‫ب‬ ‫عينة‬ ‫يدية‬‫ر‬‫و‬ ‫للطفل‬ ‫كيد‬‫لتا‬ ‫اإلصابة‬ ‫بالمرض‬ .
1 . ‫عينة‬ ‫غير‬ ‫صالحة‬ 2 . ‫نتيجه‬ ‫العينة‬ ‫قيه‬‫ر‬‫الو‬ ‫االولى‬ ( ‫اشتباه‬ ‫اصابه‬ )
• 1 . ‫نتيجة‬ ‫العينة‬ ‫قية‬‫ر‬‫الو‬ ‫ولى‬‫اال‬ ( ‫شديدة‬ ‫االيجابية‬ ّ) 25 ‫و‬‫ا‬ ‫ثر‬‫ك‬‫ا‬ • 2 . ‫نتيجة‬ ‫العينة‬ ‫قية‬‫ر‬‫الو‬ ‫الثانية‬ ( ‫شديدة‬ ‫االيجابية‬ ) 13 ‫و‬‫ا‬ ‫ثر‬‫اك‬ • 3 . ‫الطفل‬ ‫حضر‬ ‫لعمل‬ ‫التحليل‬ ‫بعد‬ ‫اتمام‬ ‫اليوم‬ ‫الساب‬ ‫ع‬ ‫من‬ ‫العمر‬ • 4 . ‫م‬‫التوا‬ ‫لطفل‬ ‫طلب‬ ‫له‬ ‫عينة‬ ‫يدية‬‫ر‬‫و‬
1 . ‫الفحوصات‬ ‫المعملية‬ ‫ال‬ ‫يمكن‬ ‫االعتماد‬ ‫على‬ ‫اض‬‫ر‬‫ع‬‫اال‬ ‫اإلكلينيكية‬ ‫للتشخيص‬ ‫في‬ ‫الفترة‬ ‫المبكرة‬ ‫ولكن‬ ‫يتم‬ ‫التشخيص‬ ‫بالفحوصات‬ ‫المعملية‬ ‫وتشمل‬ ‫الفحوصات‬ ‫المعملية‬ ‫مايلى‬ : .1 ‫الدم‬ ‫في‬‫كسين‬‫و‬‫الثير‬‫هرمون‬‫نسبة‬ ‫تحديد‬ . T3, T4 .2 ‫تحديد‬ ‫الدم‬‫في‬‫الدرقية‬ ‫للغدة‬‫المحفز‬‫الهرمون‬‫نسبة‬ . TSH • ‫كان‬‫إذا‬ ‫إيجابيا‬‫التحليل‬ ‫يثبت‬ • ‫الهرمون‬ ‫المحفز‬ ‫على‬‫ا‬ ‫من‬ ‫المعدل‬ ‫الطبيعي‬ ‫بالنسبة‬ ‫لل‬ ‫عمر‬ • ‫و‬‫ا‬ ‫كان‬ ‫هرمون‬ ‫الغدة‬ ‫الدرقية‬ ‫قل‬‫ا‬ ‫من‬ ‫المعدل‬ ‫الطبيعي‬ ‫لنف‬ ‫س‬ ‫العمر‬
.2 ‫مسح‬ ‫ى‬‫ذر‬ ‫للغدة‬ ‫الدرقية‬ .3 ‫شعة‬‫ا‬ ‫سينية‬ ‫لتحديد‬ ‫نمو‬ ‫العظام‬ . .4 ‫موجات‬ ‫فوق‬ ‫صوتية‬ ‫للعنق‬ . .5 ‫فحوصات‬ ‫ى‬‫خر‬‫ا‬ .
• ‫يتم‬ ‫العالج‬ ‫في‬ ‫عيادات‬ ‫التامين‬ ‫الصح‬ ‫ي‬ ‫عالج‬ ‫هذا‬ ‫المرض‬ ‫هو‬ ‫تعويض‬ ‫الهرمون‬ ‫الناقص‬ ‫بالجرعة‬ ‫الم‬ ‫ناسبة‬ ‫التي‬ ‫يحتاجها‬ ‫جسم‬ ‫الطفل‬ ‫للنمو‬ ‫الطبيعي‬ ‫وتحدد‬ ‫الج‬ ‫رعة‬ ‫عن‬ ‫طريق‬ ‫الطبيب‬ ‫فقا‬‫و‬‫و‬ ‫للتحاليل‬ ‫الهرمونية‬ • ‫يعطى‬ ‫العالج‬ ‫في‬ ‫ة‬‫ر‬‫صو‬ ‫اص‬‫ر‬‫ق‬‫ا‬ ( ‫كسين‬‫و‬‫التر‬ ) ‫تذاب‬ ‫في‬ ‫قليل‬ ‫من‬ ‫الما‬ ‫ء‬ . • ‫وتعطى‬ ‫للطفل‬ ‫مرة‬ ‫واحدة‬ ‫يوميا‬ ‫بالملعقة‬ ‫ويفضل‬ ‫ق‬ ‫بل‬ ‫ول‬‫ا‬ ‫رضعة‬ ‫بنصف‬ ‫ساعة‬ • ‫في‬ ‫حالة‬ ‫حدوث‬ ‫قيء‬ ‫بعد‬ ‫اعطاء‬ ‫الدواء‬ ‫مباشرة‬ ( ‫او‬ ‫في‬ ‫خال‬ ‫ل‬ ‫نصف‬ ‫ساعه‬ ) ‫ر‬‫تكر‬ ‫الجرعة‬
‫يقوم‬ ‫طبيب‬ ‫عيادة‬ ‫التامين‬ ‫الصحى‬ ‫بمتابعة‬ ‫الطفل‬ ‫بالف‬ ‫حص‬ ‫اإلكلينيكي‬ ‫لنمو‬ ‫الطفل‬ ( ‫زن‬‫و‬ ‫الطفل‬ ‫وطوله‬ ‫ومحيط‬ ‫س‬‫ا‬‫ر‬‫ال‬ ) ‫احل‬‫ر‬‫وم‬ ‫نموه‬ ‫و‬ ‫ه‬‫ر‬‫تطو‬ ‫و‬ ‫عمل‬ ‫التحاليل‬ ‫الهرمونية‬ ‫للغدة‬ ‫الدرقية‬ . .1 ‫مرة‬ ‫كل‬ ‫سبوعين‬‫ا‬ ‫حتى‬ ‫انتظام‬ ‫التحاليل‬ .2 ‫ثم‬ ‫مرة‬ ‫كل‬ ‫شهر‬ ‫خالل‬ ‫العام‬ ‫االول‬ .3 ‫ثم‬ ‫مرة‬ ‫كل‬ ‫شهرين‬ ‫خالل‬ ‫العام‬ ‫الثاني‬ .4 ‫ثم‬ ‫مرة‬ ‫كل‬ ‫ثالثة‬ ‫ر‬‫شهو‬ ‫خالل‬ ‫العام‬ ‫الثالث‬ .5 ‫ثم‬ ‫مرة‬ ‫كل‬ 6 ‫شهر‬‫ا‬ . .6 ( ‫تجربة‬ ‫ايقاف‬ ‫عند‬ 2 - 3 ‫سنوات‬ ) ....
‫يتم‬ ‫إعادة‬ ‫تقييم‬ ‫الحالة‬ ‫عندما‬ ‫يبلغ‬ ‫الطفل‬ 3 ‫سنوات‬ . ‫يتم‬ ‫وقف‬ ‫العالج‬ ‫مؤقتا‬ ‫و‬ ‫م‬ ‫اقب‬‫ر‬ ‫ة‬ ‫الطفل‬ ‫إكلينيكيا‬ ‫و‬ ‫معمليا‬ ‫كد‬‫للتا‬ ‫من‬ ‫احتياجه‬ ‫للهرمون‬ ‫فإذا‬ ‫ثر‬‫تا‬ ‫الطفل‬ ‫بتوقف‬ ‫العالج‬ ‫كان‬ ‫ذلك‬ ‫داال‬ ‫على‬ ‫حاجة‬ ‫هذا‬ ‫الطفل‬ ‫للهرمون‬ ‫التعويضي‬ ‫مدى‬ ‫الح‬ ،‫ياة‬ ‫وهذا‬ ‫ما‬ ‫يحدث‬ ‫في‬ ‫معظم‬ ‫الحاالت‬
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محاضرات الغدة ومرض الغدة.pptx