Bnh tuyn gip

TS. Nguyn Th DnCN B mn Gii phu bnh H.V.Q.Y.

Bnh tuyn gip Tuyn gip to c th do cc bnh: - Bu gip n thun (Goitre) - Cc vim tuyn gip (Riedel) - Tng chc nng tuyn gip (Basedow) - Gim chc nng tuyn gip (Hashimoto) - U lnh (adenoma) - Ung th (carcinoma)Phm vi bi hc: Bnh Basedow, u tuyn tuyn gip, ung th tuyn gip.

Bnh Basedow(Graves disease) - Bnh Basedow l bnh cng chc nng tuyn gip vi c im l qu sn lan to cc nang tuyn v tng ch tit hormon (T4, T3). - Biu hin lm sng: ngi gy, bu c, mt li, mch nhanh, tay run, hay hi hp lo u, tng huyt p, tng chuyn ho c bn.

+ C ch bnh sinh L bnh t min, c th xut hin t khng th IgG (LATS: long-acting thyroid stimulator). LATS gn vi cc t bo biu m tuyn gip, hn ch tc ng ca TSH, kch thch cc t bo nang tuyn tng sn v tng ch tit hormon T4, T3.

+ Tn thng Gii phu bnhi th: Tuyn gip to va, i xng, cng mng, xung huyt. Mt mm, mt ct ng nht (thun nht) mu hng nh tht.Vi th:- Cc nang tuyn tng sn, biu m tr cao, nhiu hng t bo, c ch to thnh nh.- Cc tuyn cha t cht keo long, nhiu l ht.- M m c nhiu mch mu xung huyt v c xm nhp nhiu lympho thnh m.

Bnh Basedow

i th, bnh Basedow

Vi th, bnh Basedow

Vi th, bnh Basedow

Vi th, bnh Basedow

U tuyn tuyn gip(adenoma of the thyroid gland) Khi tuyn gip xut hin mt cc chc to (solitary thyroid nodule), phu thut ct b l cn thit. Trc khi phu thut cn lm chn on t bo xc nh: - Bnh bu gip n thun (goitre) ? - U tuyn tuyn gip (adenoma) ? - Ung th tuyn gip (thyroid carcinoma) ?

U tuyn tuyn gip (adenoma) L u lnh tnh, nh, tin trin chm, thng khng biu hin triu chng lm sng. i th: U chc, nh (

i th, u tuyn tuyn gip

i th, u tuyn tuyn gip

Vi th, u tuyn tuyn gip

Vi th, u tuyn tuyn gip

Vi th, u tuyn tuyn gip

Vi th, u tuyn tuyn gip

Ung th tuyn gip(thyroid carcinoma) L u c tnh ca t bo biu m nang tuyn. C 4 th loi khc nhau v din bin v tin lng: - UT TG th nh (papillary carcinoma). - UT TG th nang (follicular carcinoma). - UT TG th km bit ho (anaplastic carcinoma). - UT TG th tu (medullary carcinoma)

- UT TG th nh (papillary carcinoma) L UT bit ho cao, hay gp ph n tr (30 40). Chim 80% cc UT tuyn gip. UT thng nhiu . Di cn mun n hch lympho vng c. UT pht trin chm, tin lng tt. t di cn xa.i th: UT khng c gianh gii r, m u mm, xp, c nhng vng trng do x ho.Vi th: Cc tuyn UT bt mu m, c nhiu hnh nh li vo lng tuyn. Cc nh c trc lin kt mnh.

- UT TG th nang (folicular carcinoma) UT t gp (15%), hay gp n (75 %) tui trung nin, hay di cn theo ng mu n xng. BN c th c du hiu gy xng bnh l do di cn trc khi pht hin u nguyn pht. p ng tia x tt.i th: Pht trin ging nh u tuyn. U n c c v bc, c gianh gii r, nhng vn c th xm nhp v v mch mu.Vi th: UT to thnh nhiu hnh nang tuyn ging nang tuyn bnh thng, t bo tr cao, nhiu hng, bo tung sng, t cht ch tit. C th thy hnh nh TB u xm nhp mch mu.

- UT TG th km bit ho (anaplastic carcinoma) UT hay gp ngi gi, pht trin nhanh, xm nhp mnh vo kh qun, m mm xung quanh tuyn gip, thng p kh qun hoc xm nhp tnh mch vng c. Tin lng xu.i th: U cng chc mu trng ng, pht trin nhanh, khng c gianh gii r, p xm nhp kh qun v phn mm xung quanh. Vi th: Khng thy hnh nh tuyn hoc nh. Nhng t bo u thng nh, km bit ho, d nhm vi cc t bo u lympho c tnh (l loi u c tnh gp ngi gi nhng p ng iu tr tia x tt).

- UT TG th tu (medullary carcinoma) - Khc vi nhng th UT TG khc, UT TG th tu c ngun gc t t bo C tit calcitonin. T bo UT tit ra cht calcitonin. - Vi th: khi u gm nhng t bo thn kinh ni tit hnh trn hoc bu dc ng thnh m, thnh di. Cht m u cha nhiu cht dng tinh bt (amyloid) l cht c ngun gc l calcitonin. - UT c tnh di truyn, thng xy ra ng thi vi cc UT thn kinh ni tit khc nh u tuyn thng thn (pheochromocytoma), u tuyn cn gip.

i th, UT TG xm nhp kh qun v m mm xung quanh

i th, UT TG th tu

UT TG th nh (papillary carcinoma)

UT TG th nh (papillary carcinoma)

UT TG th nh (papillary carcinoma)

UT TG th nh (papillary carcinoma)

UT TG th nh (papillary carcinoma)

UT TG th nang (folicular carcinoma)

UT TG th nang (folicular carcinoma)

UT TG th nang, xm nhp mch mu

UT TG th nang (folicular carcinoma)

Vi th, UT TG th km bit ho

Vi th, UT TG th km bit ho

Vi th, UT TG th tu

Vi th, UT tuyn gip th tu

Vi th, UT tuyn gip th tu

U tuyn cn gip (parathyroid adenoma)

U tuyn cn gip (parathyroid adenoma)

Tng sn tuyn cn gip (parathyroid hyperplasia)