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Gusa endemica
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Gusa endemica
1.
Glanda tiroida Gusa
2.
Istoria chirurgiei tiroidiene •
Claudius Galen (129 - 199); • Andreas Vesalius (1514 - 1564) - prima descriere a anatomiei tiroidiene; • Th. Warton 1656 • R.J. Graves (1796 - 1853); • K.A. von Basedow (1799 - 1854); • Th. Kocher (1883) - recomanda tiroidectomie subtotala; Premiu Nobel • C.I. Parhon, St. Milcu, I. Muresan.
3.
Anatomia tiroidei
4.
Anatomia tiroidei
5.
Anatomia tiroidei
6.
Anatomia tiroidei
7.
Anatomia tiroidei
8.
Anatomia tiroidei
9.
Anatomia tiroidei
10.
Anatomia tiroidei
11.
Fiziologia glandei tiroide •
Biosinteza hormonala
12.
Fiziologia glandei tiroide •
Secretia hormonala
13.
Fiziologia glandei tiroide
14.
Fiziologia glandei tiroide •
Controlul secretiei hormonale
15.
Mecanism de actiune
al hormonului tiroidian • Nivel de actiune: – nuclear – mitocondrial – membrana celulara • Efecte metabolice: – calorigeneza – metabolism proteic, glucidic si lipidic
16.
Gusa Gusa difuza Endemica •Deficitul
de iod •Excesul de iod •Factori alimentari Sporadica •Defect congenital al biosint. •Droguri si substante chimice Compensatorie •Deficit de iod •Dupa tiroidect. subtotala Gusa nodulara •Uni sau plurinodulara Definitie Clasificare
17.
Epidemiologia • 5 %
din populatie • Zone endemice
18.
Etiologia • Deficitul de
iod cel mai important factor • Alti factori: exces de iod, minerale, defecte congenitale
19.
Patogenie Hiperplazia tiroidiana prod.
sub act. fact de stimulare a cresterii tiroidiene Factori extratiroidieni: • Deficit de iod - TSH - hiperplazie tiroidiana • GSI (thyroid – growth – stimulating – immunoglobulin) Factori intratiroidieni (citokine) Heterogenitatea morfologica si functionala
20.
Morfopatologie • Difuza: – microfoliculara –
macrofoliculara • Nodulara: – uninodulara – multinodulara • Modificari ale tesutului conjunctiv: – fibroase – calcificate
21.
Morfopatologie • Gusa adenochistica
22.
Morfopatologie Adenomul tiroidian Tiroida normala
23.
Studiu clinic • Anamneza •
Examen clinic • Clasificare clinica: – 0 – Ia – Ib – II – III
24.
Examenul clinic
25.
Examen paraclinic Morfologice • Radiografia cervicala
26.
Examen paraclinic Morfologice Radiografia toracica
27.
Examen paraclinic Morfologice • Ecografia
28.
Examen paraclinic Morfologice • Scintigrafia tiroidiana
29.
Examen paraclinic Morfologice • Computer
tomograf • RMN • Punctia tiroidiana cu ac subtire • Ex ORL
30.
Examen paraclinic Computer tomograf
31.
Examen paraclinic Computer tomograf
32.
Examen paraclinic Functionale • TSH •
fT4, fT3, T4, T3 • Teste de stimulare • Anticorpi antitiroidieni
33.
Diagnosticul diferential Alte afectiuni
tiroidiene: • Cancerul tiroidian • Tiroiditele • Hipertiroidiile Alte tumori cervicale
34.
Complicatii • Compresiuni • Hipotiroidie •
Hipertiroidie • Malignizare
35.
Forme clinice • Etiologice •
Localizare: – retrosternala – mediastinala – linguala – esofagiana – traheala – ovariana
36.
Tratament • Profilactic • Medical •
Chirurgical
37.
Tratament chirurgical Indicatii: –Gusi voluminoase –Gusi
compresive –Gusi uninodulare –Gusi maligne sau cu suspiciune de malignizare –Gusi retrosternale –Gusi ectopice –Imposibilitatea tratamentului medical –Ratiuni estetice
38.
Tratament Chirurgical Tiroidectomia subtotala Incizie
39.
Tratament Chirurgical Tiroidectomia subtotala
40.
Tratament Chirurgical Tiroidectomia subtotala
41.
Tratament Chirurgical Tiroidectomia subtotala
42.
Tratament Chirurgical Tiroidectomia subtotala
43.
Tratament Chirurgical Tiroidectomia subtotala
44.
Tratament Chirurgical Tiroidectomia subtotala
45.
Tratament Chirurgical Tiroidectomia subtotala
46.
Complicatii postoperatorii • Hemoragii •
Leziuni ale nervului recurent • Insuficienta paratiroidiana • Hipotiroidie • Recidiva
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