Hipertiroidia
-
Upload
alexvelcelean -
Category
Health & Medicine
-
view
1.819 -
download
3
Transcript of Hipertiroidia
![Page 1: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/1.jpg)
HIPERTIROIDIA(Tireotoxicoza)
Hipertiroidia reprezinta un sindrom cu manifestari multisistemice indus de excesul de hormoni tiroidieni la nivel de receptor
![Page 2: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/2.jpg)
ETIOLOGIA ETIOLOGIA TIREOTOXICOZEITIREOTOXICOZEI
CCaauuzzee ddeetteerrmmiinnaannttee aallee hhiippeerrffuunnccttiieeii ttiirrooiiddiieennee
•• BBooaallaa GGrraavveess –– BBaasseeddooww
•• AAddeennoommuull ttooxxiicc
•• HHiippeerrttiirrooiiddiiaa iinndduussaa ddee iioodd ((iioodd--BBaasseeddooww))
•• GGuussaa ttooxxiiccaa mmuullttiinnoodduullaarraa
•• TTuummoorrii ttrrooffoobbllaassttiiccee ((ccuu aaccttiivviittaattee TTSSHH--lliikkee))
•• AAddeennooaammee hhiippooffiizzaarree TTSSHH--sseeccrreettaannttee
• CCaarrcciinnoomm ttiirrooiiddiiaann ffoolliiccuullaarr mmeettaassttaazzaannttCCaauuzzee ccaarree nnuu iimmpplliiccaa oo hhiippeerrffuunnccttiiee ttiirrooiiddiiaannaa
•• TTiirroottooxxiiccoozzaa ffaaccttiittiittiiaa
•• SSttrruummaa oovvaarriiii
![Page 3: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/3.jpg)
Hipertiroidia autoimunaBoala Graves Basedow
• Gusa
• Exoftalmie
• Semne de tireotoxicoza
![Page 4: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/4.jpg)
Axul hipotalamo-tiroidiansi caile
extratiroidiene a hormonilor tiroidieni
Etiopatogenia HipertiroidieiTeoria corticodiencefalohipofizara
![Page 5: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/5.jpg)
ETIOPATOGENIA BOLII GBETIOPATOGENIA BOLII GB
• Patogenia autoimuna - 1956 teoria LATSPatogenia autoimuna - 1956 teoria LATS
– prezenta thyroid – stimulating immunoglobulins prezenta thyroid – stimulating immunoglobulins
la peste 90 % din pacienti .TSI se leaga de la peste 90 % din pacienti .TSI se leaga de
receptorul TSH de pe membrana folicularareceptorul TSH de pe membrana foliculara
– Factori ce influenteaza evolutia:Factori ce influenteaza evolutia:– ereditateaereditatea– sexulsexul– stress-ulstress-ul
![Page 6: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/6.jpg)
Patologia bolii Graves-BasedowPatologia bolii Graves-Basedow
MACROSCOPICMACROSCOPIC MICROSCOPICMICROSCOPIC
![Page 7: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/7.jpg)
OftalmopatiaOftalmopatia
• de tip retractilo - palpebral
• de tip infiltrativ
• LATS (long - acting thyroid stimulator)
• EPS (exophthalmic – producing substance)
![Page 8: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/8.jpg)
Efectele excesului hormonilor tiroidieni asupra organismului
![Page 9: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/9.jpg)
Simptomele hipertiroidieiSimptomele hipertiroidiei
• nervozitatenervozitate
• labilitate emotionalalabilitate emotionala
• palpitatiipalpitatii
• intoleranta la calduraintoleranta la caldura
• atrofie musculara, fatigabilitateatrofie musculara, fatigabilitate
• apetit crescutapetit crescut
• transpiratiitranspiratii
• dispneedispnee
![Page 10: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/10.jpg)
Semnele hipertirodieiSemnele hipertirodiei
• gusagusa• cardiotireoza: tahicardie, fibrilatie atrialacardiotireoza: tahicardie, fibrilatie atriala• pierdere in greutatepierdere in greutate• sindrom hiperkineticsindrom hiperkinetic• edemul pretibial, acropachiaedemul pretibial, acropachia• miopatiemiopatie• semne oculare (retractia palpebrala, semne oculare (retractia palpebrala, oftalmopatie infiltrativa)oftalmopatie infiltrativa)
![Page 11: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/11.jpg)
SEMNE ALE SEMNE ALE HIPERTIOROIDIEHIPERTIOROIDIE
SEMNE OCULARESEMNE OCULARE
![Page 12: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/12.jpg)
Dignosticul paraclinicDignosticul paraclinic
• dozarea TSH scazuta
• fT4, fT3 crescut
• TT4, TT3 crescute
• dozarea TSI
• scintigrafia tiroidiana si curba iodocaptarii
• ecografia tiroidana
• exoftalmometria
![Page 13: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/13.jpg)
A Scintigrafie tiroidiana normala cu I 131B Scintigrafie tiroidiana cu Tc 99
![Page 14: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/14.jpg)
Scintigrafie tiroidiana = gusa toxica multinodulara la o femeie de 71 de ani
![Page 15: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/15.jpg)
Scintigrafie tiroidiana color la un pacient cu boala Graves Basedow
![Page 16: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/16.jpg)
Scintigrafie tiroidiana color la un pacient cu adenom toxic tiroidian
![Page 17: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/17.jpg)
ESENTIAL PENTRU ESENTIAL PENTRU DIAGNOSTICDIAGNOSTIC
• GUSAGUSA
• TAHICARDIATAHICARDIA
• SEMNE OCULARESEMNE OCULARE
• SCADEREA IN GREUTATESCADEREA IN GREUTATE
• TREMURATURITREMURATURI
• IRITABILITATE, TULBURARI IRITABILITATE, TULBURARI EMOTIONALEEMOTIONALE
![Page 18: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/18.jpg)
Diagnosticul diferentialDiagnosticul diferential• Cu alte afectiuni ce pot imita hipertiroidia:Cu alte afectiuni ce pot imita hipertiroidia:
– neurastenia, feocromocitomulneurastenia, feocromocitomul
– diabetul zaharat, ciroza hepaticadiabetul zaharat, ciroza hepatica– afectiuni mielo-proliferativeafectiuni mielo-proliferative– BPOC, atrofia musculara progresiva, polimiozitaBPOC, atrofia musculara progresiva, polimiozita– etilismul cronic, inoxicatia cu nicotinaetilismul cronic, inoxicatia cu nicotina
• Cu alte afectiuni tiroidiene:Cu alte afectiuni tiroidiene:
– parabasedow-ul pubertatiiparabasedow-ul pubertatii– hashi-toxicoza, tiroidita de Quervain ,tiroidita painlesshashi-toxicoza, tiroidita de Quervain ,tiroidita painless– cancerul tiroidian cu hiperfunctiecancerul tiroidian cu hiperfunctie
![Page 19: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/19.jpg)
Diagnosticul diferentialDiagnosticul diferential
• Diagnosticul diferential al formelor clinice:Diagnosticul diferential al formelor clinice:
– hipertiroidia primara, hipertiroidiile secundare hipertiroidia primara, hipertiroidiile secundare
(sd.Plummer, sd. Milcu), boala Graves Basedow, (sd.Plummer, sd. Milcu), boala Graves Basedow,
adenomul toxic tiroidian, iod-basedow-uladenomul toxic tiroidian, iod-basedow-ul
• Dianosticul diferential al oftalmopatiei:Dianosticul diferential al oftalmopatiei:
– neoplasmul orbitar, tromboza sinusului cavernosneoplasmul orbitar, tromboza sinusului cavernos
![Page 20: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/20.jpg)
EVOLUTIE SI COMPLICATIIEVOLUTIE SI COMPLICATII
• Stadii evolutive:Stadii evolutive:• I = neuroticI = neurotic
• II = neuroendocrinII = neuroendocrin
• III = visceralizareIII = visceralizare
• IV = maranticIV = marantic
![Page 21: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/21.jpg)
TRATAMENTTRATAMENT
• ANTITIROIDIENE DE SINTEZAANTITIROIDIENE DE SINTEZA
• IOD RADIOACTIVIOD RADIOACTIV
• CHIRURGICALCHIRURGICAL
![Page 22: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/22.jpg)
ANTITIROIDIENE DE ANTITIROIDIENE DE SINTEZASINTEZA
• PROPIL-TIOURACILPROPIL-TIOURACIL
• METHIMAZOLEMETHIMAZOLE
• CARBIMAZOLECARBIMAZOLE
- Interfera cu cuplarea iodului- Interfera cu cuplarea iodului
- Interfera cu sinteza hormonilor tiroidieni - Interfera cu sinteza hormonilor tiroidieni
![Page 23: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/23.jpg)
Tratamentul hipertiroidiei
• Succesul terapiei• Recurenta• Efecte secundare
• Contraindicatii
- Da- < 72 %
- Agranulocitoza- Nevrita periferica- Hepatita- Mialgia, artralgia- Adenopatia- Psihoza- Alergie- Toxicitate
Antitiroidiene de sinteza
![Page 24: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/24.jpg)
Tratamentul hipertiroidiei
• Succesul terapiei• Recurenta• Efecte secundare
• Contraindicatii
- Da- < 10 %
- Hipotiroidie permanenta in 40 - 70 % la 10 ani
- Sarcina
Iod radioactiv
![Page 25: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/25.jpg)
Tratamentul hipertiroidiei
• Succesul terapiei• Recurenta• Efecte secundare
• Contraindicatii
- Da- < 10 %
- Hipotiroidie postoperatorie < 15 %
- Hipoparatiroidie permanenta, lezarea nervului laringeu recurent, rareori
- Nu
Chirurgia
![Page 26: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/26.jpg)
Prevalenta hipotiroidismului dupa tratamentul cu iod radioactiv in
comparatie cu tiroidectomia subtotala
![Page 27: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/27.jpg)
INDICATIILE TIROIDECTOMIEI INDICATIILE TIROIDECTOMIEI SUBTOTALESUBTOTALE
• Gusi mari, compresiveGusi mari, compresive
• Gusi multinodulareGusi multinodulare
• Nodul tiroidian suspect de malignizareNodul tiroidian suspect de malignizare
• Asocierea gusa - sarcinaAsocierea gusa - sarcina
• Intoleranta la antitiroidienele de sintezaIntoleranta la antitiroidienele de sinteza
• Contraindicatiile iod-ului radioactivContraindicatiile iod-ului radioactiv
![Page 28: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/28.jpg)
Tiroidectomia subtotala
![Page 29: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/29.jpg)
![Page 30: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/30.jpg)
![Page 31: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/31.jpg)
![Page 32: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/32.jpg)
![Page 33: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/33.jpg)
![Page 34: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/34.jpg)
![Page 35: Hipertiroidia](https://reader034.fdocumente.com/reader034/viewer/2022042817/55a8e1741a28ab3f6a8b456d/html5/thumbnails/35.jpg)