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Спорадична гуша

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Спорадична гуша

  1. 1. Гушавост Спорадична гуша
  2. 2. определение <ul><li>Заболяване на тиреоидеята, несвързано с йоден недоимък в определени географски район, което се характеризира с хиперпластични промени и нарастване на жлезата без прояви на хипер- или хипотиреоидизъм </li></ul>
  3. 3. Класификация <ul><li>Спорадична(не ендемична) </li></ul><ul><li>Ендемична(йод дефицитна) </li></ul><ul><li>Автоимунна </li></ul><ul><li>Неоплазми </li></ul><ul><li>Генетично обусловена </li></ul><ul><li>Следствие струмигени </li></ul>
  4. 4. Клинична и морфологична класификация <ul><li>Дифузна </li></ul><ul><li>Нодуларна </li></ul><ul><li>Токсична </li></ul><ul><li>Не токсична </li></ul>
  5. 5. Патогенеза <ul><li>Итратиреоидни-хрон. ТСХ стимулация, стимулиращи растежа имуноглобулини, епидермален растежен фактор, инсулин подобен раст. фактор,интерлевкин, интерферон, ТГФ-бета, генетични причини </li></ul><ul><li>Екстратиреоидни-фактори на околната среда, хранителни в-ва, тютюнопушене и др. </li></ul>
  6. 6. Физикален преглед <ul><li>Най- често асимптомнна </li></ul><ul><li>Кашлица, диспнея, дисфагия, натиск , болка в шията. </li></ul>
  7. 7. 81г. Пациентка с дифузна еутиреоидна струма
  8. 8. Лабораторни и радиологични изследвания <ul><li>Определяне хормонални нива- ТСХ, ФТ4 , ФТ3 </li></ul><ul><li>УЗТ- диагностика и КТ </li></ul><ul><li>Сцинтиграфия-индикации: </li></ul><ul><li>диагностика на нодули </li></ul><ul><li>Детерминиране размера на гушата </li></ul><ul><li>Субстернална гуша </li></ul><ul><li>Ектопична тиреоидея </li></ul>
  9. 9. Four different 99mTc scan patterns. ( A ) Normal thyroid, showing function in both lobes connected by the isthmus. ( B ) A 38-year-old man with hyperthyroid Graves’ disease, thyroid-stimulating hormone (TSH) of 0.006 mIU/L, and radioiodine uptake of 92%. Note that the scan shows enlarged thyroid gland with intense and diffuse uptake.( C ) A 38-year-old woman with a palpable, 2-cm cold nodule in the right thyroid lobe. The nodule was benign on biopsy. ( D ) A 39-year-old man with a palpable 3-cm right thyroid nodule, hyperfunctioning on scan, with completely suppressed uptake in the rest of the gland. Serum level of TSH was 0.05 mIU/L and radioiodine uptake was 22%.
  10. 10. КТ на шия при уголемен предимно ляв лоб
  11. 11. Биопсия <ul><li>4 диагностични групи-бенигнени, клинично подозрителни, малигнени и не диагностични </li></ul>
  12. 12. Thyroid cytology. ( A ) Nondiagnostic smear. Degenerative foam cells without follicular cells (PAP; Ч60). ( B ) Colloid nodule. Cohesive group of thyroid cells in a patient with multinodular goiter (PAP; Ч50). ( C ) Hashimoto thyroiditis. Lymphocytes and H¨urthle cells showing abundant granular cytoplasm (PAP; Ч250). ( D ). Follicular neoplasm. Hypercellular aspirate with microfollicular pattern lacking colloid is indeterminate (PAP; Ч205). Nodule was a benign follicular adenoma at surgery ( E ) Papillary carcinoma. Cellular specimen showing tumor cells with irregular, enlarged nuclei. Note lack of colloid(PAP; Ч100). ( F ) Medullary carcinoma. Loosely cohesive neoplastic cells with elongated nuclei. (MGG stain; Ч400). Abbreviations : MGG, May–Grunwald–Giemsa stain; PAP,Papanicolaou stain.
  13. 13. Терапия <ul><li>Тиреоидна хормонална терапия </li></ul><ul><li>Хирургия </li></ul>
  14. 14. Reduction of nodule volume of at least 50% (random effects model). The right side indicates improvement in reduction. The size of the filled diamond at the middle of the central line ( arrow 1) represents the sample size of each study. The box ( arrow 2)represents the 95% confidence interval (CI) of the relative risk (RR; marked with a line inhe box). The unfilled diamond with a central line ( arrow 3) denotes the pooled risk ratio itself. Abbreviation : T4, levothyroxine. Source : From Ref. 96.
  15. 15. Management of patient with a multinodular goiter (MNG). Evaluation begins by determining thyroid-stimulating hormone (TSH) levels; suppressed TSH (0.1 mIU/L) suggests subclinical or clinical hyperthyroidism and the patient is treated accordingly. Most often, when TSH is normal (nontoxic goiter), fine-needle aspiration (FNA) biopsy results decide management. Benign and/or small goiters are followed without thyroxine therapy. Symptomatic, large MNGs are treated with either surgery or radioiodine (131I). Malignant goiters are surgically excised. Abbreviations : FT4, free thyroxine; N, normal;RAIU, radioiodine uptake; Rx, therapy; T3, triiodothyronine; US, ultrasound.

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