Tiroid Guatr Hastalıkları Dr.Ceyhun İrgil
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Transcript of Tiroid Guatr Hastalıkları Dr.Ceyhun İrgil
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OMENA CERRAHİ MERKEZİ
Tiroid Hastalıkları
OMENA CERRAHİ MERKEZİ
Tiroid Hastalıkları
Opt.Dr.Ceyhun İRGİL
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TİROİD BEZİ
• 20 gram ağırlığında• 2 loptan oluşan• trakeanın önünde
yerleşmiş• iç salgı fonksiyonu
olan
BİR ORGANDIR
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TİROİD BEZİNİN İLTİHABİ VETÜMÖRAL NEDENLER DIŞINDA
KALAN BÜYÜMELERİNİ
GUATR
DENİR
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TİROİD BEZİ HORMONU
• Dokularda metabolik aktiviteyi ayarlar
• Besinlerden enerji kullanımını ayarlar
• Protein sentezi ve kullanılmasını ayarlar
• Gençlerde büyüme hızını ayarlar
• Beyin işlevlerini ayarlar
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TİROİD BEZİNİN DOKU YAPISI
• Fizik muayene
• Ultrasonografi
• Sintigrafi
• İnce iğne biopsisi
İLE İNCELENİR.
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TİROİD BEZİNİN FONKSİYONU KANDAKİ
• T3 T4 TSH
• sT3 sT4 sTSH
• T3Ru FTI
HORMON DÜZEYLERİNE BAKILARAK ÖLÇÜLÜR
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TİROİD BEZİNİN HASTALIKLARI İKİ ANA GRUPTA İNCELENİR;
• Bezin fonksiyonu ile ilgili bozukluklar
• Bezin doku yapısındaki bozukluklar
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TİROİD BEZİNİN YAPISAL VE FONKSİYONEL BOZUKLUKLARI
BİRBİRLERİNDEN BAĞIMSIZ OLARAK GÖRÜLEBİLİRLER, NORMAL GÖRÜNEN BİR TİROİD BEZİ ÇOK FAZLA HORMON ÜRETİRKEN ÇOK BÜYÜK BİR TİROİD BEZİ NORMAL, MİKTARDA HORMON
ÜRETEBİLİR.
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TİROİD BEZİNİN DOKU YAPISINDAKİ BOZUKLUKLAR
• Nodüller (Kistik ve solid)
• Guatrlar (Diffüz veya nodüler)
• Kanserler
• Enfeksiyonlar
• İmmun Hastalıklar
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TİROİD BEZİ BÜYÜMESİ HOMOJEN İSE
DİFFÜZ GUATR,
NODÜLLER VE / VEYA KİSTLERDE İÇERİYORSA
NODÜLLER GUATR
DENİR
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DİFFÜZ GUATR, NEDENİNE GÖRE ÖNCELİKLE İLAÇ İLE TEDAVİ
EDİLİR.
NODÜLER GUATR, NODÜLLERİNİN YAPISI ve SAYISINA GÖRE TAKİBE
ALINIR VEYA CERRAHİOLARAK TEDAVİ EDİLİR.
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TİROİD NODÜLLERİ
• Çocuklarda % 0.22 - 1.5 oranında görülür Kanser riski % 15 - 40’tır.
• Yetişkinlerde % 4 - 7 oranında görülür Kanser riski % 10 - 20’dir.
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TEK NODÜLÜ OLAN 15 YAŞIN ALTINDAKİ
ve65 YAŞIN ÜZERİNDEKİ
HASTALARDA
KANSER RİSKİ %45’TİR
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TİROİD NODÜLLERİNİN TEDAVİSİNDE • İlaç tedavisine rağmen nodüllerde büyüme varsa • İğne biyopsisinde kanser ve kuşkusu varsa• 15 yaş altı ve 65 yaş üzeri tek nodüllerde • Kozmetik gerekçeler varsa• Zehirli Guatr ve ilaç ile tedavi olmuyorsa• Bası bulguları varsa• Kuşkulu TEK NODÜLLERDE
CERRAHİ UYGULANIR
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CERRAHİ UYGULANMAYAN TİROİD NODÜLLERİ
MUTLAKA TAKİP EDİLMELİDİR
CERRAHİ UYGULANMAYAN TİROİD NODÜLLERİ
MUTLAKA TAKİP EDİLMELİDİR
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TİROİD BEZİ KANSERİ NEDENLERİ
• İyot yetersizliği (?)
• Radyasyon
• Guatr oluşturacak uyarılar
• Genetik Faktörler
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TİROİD BEZİ KANSERLERİ
• Papilller karsinom (%55 - 60)
• Folliküler karsinom (%25)
• Medüller karsinom (%7 - 10)
• Anaplastik karsinom (%10)
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TİROİD BEZİ KANSERİ TEDAVİSİ
• Cerrahi
• Radyoaktif iyot
• Eksternal Radyoterapi
• Kemoterapi
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FONKSİYONLARDAKİ DEĞİŞİKLİKLERE GÖRE TİROİD
BEZİ HASTALIKLARI
• Ötiroidi
• Hipertiroidi
• Hipotiroidi
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HİPERTİROİDİ BELİRTİLERİ• Sinirlilik ve titreme• Sıcağa dayanıksızlık• İştah artması - kilo kaybı• Çarpıntı• Ruhsal Düzensizlik• Artmış dışkılama• Kas krampları• Ekzoftalmi (Gözlerin çıkıklaşması)
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HİPERTİROİDİ TEDAVİSİ
• İlaç tedavisi
• Radyoaktif iyot tedavisi
• Cerrahi tedavi
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HİPOTİROİDİ BELİRTİLERİ• Halsizlik
• Soğuğa dayanıksızlık
• Unutkanlık
• İştahsızlık
• Deri ve saçların kuruması, kalınlaşması
• Çevreye ilgisizlik
• Adet düzeni değişikliği
• Dilin kalınlaşması
• Reflekslerse yavaşlama
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HİPOTİROİDİ TEDAVİSİ
• İyot replasmanı
• Tiroid hormon replasmanı
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A.B.D.’DE YILDA 72.000 TİROİD AMELİYATI YAPILMAKTADIR.
50 YAŞIN ALTINDA, TOKSİK ve KANSER OLMAYAN HASTALARDA
AMELİYAT NEDENİYLE ÖLÜM ORANI %0.02’DİR.