Tiroida

Question 1

Tiroidite:

Answer 1

Acute
Subacute
Cronice

Question 2

Toroidita de Quervain

Answer 2

Subacuta granulomatoasa/pdeudotuberculoasa/cu cel gigante

Etiologie: necunoscuta, inf urliana, strept

Frecvent la femei >30-50
Nesupuratuva, autolimitata, foliculi pseudotub.
FARA ADENOPATII
Iodocaptare 0

Tratament:
Cortico terapie 2 luni
Hormoni
Radioterapie
Tiroidectomie

Question 3

Clasificare tnm cancer tiroidian

Answer 3

T1 0-1cm
T2 1-4 cm
T3 >4 cm
T4 depasirea capsulei

N1a regionala homolaterala
N1b bilat, contralat, mediastinala

Question 4

Endrocrine influentate de toroida

Answer 4

Paratiroide
Timus
Ovar
Suprarenale

Question 5

Anamneza tiroidei

Answer 5

Debut
Crestere
Durere
Semne de hiper/hipo functie
Habitat

Question 6

Explorari functionale tiroida

Answer 6

Iodocaptare:
-2h: 10-15%
-4h: 25-30%
-24h: 40-50%
-72h: 15-20%

Clearence de iod
Dozarea iodului
Hormonii tiroidieni
Ac anti tiroidieni
Scintigrafia tiroidiana cu iod
Rx cervicala si toracica, cap
Eco
Ct
Rmn
Puntie aspirativa
Ekg
Laringoscopie
Scintigrafie osoasa

Question 7

Definitie gusa

Answer 7

Orice marire de volum a glandei datorata unui proces hiperplazic de natura distrofica, localizat la foliculi sau in tesutul conjunctiv

Question 8

Clasificare guse

Answer 8

Congenitale
Dobandite
Endemice
Sporadice(fiziologice)

Question 9

Factori determinanti gusa

Answer 9

Mediu:
Carenta iod
Apa poluata
Alimente gusogene
Ca,Mg, F, Cl
Medicamente
Iod in cantitate mare

Individual:
Genetic
Neuro-endocrini
Varsta(pubertate, menopauza)
Tulb de hormonogeneza
Pierderi cronice iod(diaree, alaptare)

Question 10

Forme anatomopat. Gusa

Answer 10

1. Parenchimatoasa difuza
   Pubertate/primul an
   Macro:elastica, omogena, neteda
   Micro:arhitectura pastrata, creste nr de foliculi, cantitatea de colid
   Hemoragii+scleroza
2. Coloidala
   Cea mai frecv gusa endemica
   Macro:mare, consistenta moale
   Micro:-mult coloid, aplatizare eliteliu
3. Nodulara
   Macro: noduli mari ce evolueaza ca adneoame
   Micro: adenoame cu structuri diferite, cu aplatizarea epiteliului, pote transf malign
4. Chistica
   Macro: chist unic sau multiplu cu vegetatii in interior
   Micro: epiteliu aplatizat, cu proliferari endochistice

Question 11

Examen obiectiv tiroida

Answer 11

Volum
Mobilitatea cu deglutitia
Semne de compresiune
Semne de hiper/hipofunctie
Adenopatii

Question 12

Paraclinic Gusa

Answer 12

Iodocaptare
T3,T4
Test stimulare tsh
Scintigrafie
Rx
Eco
Ct

Question 13

Complicatii gusa

Answer 13

Hipo/hiperfunctie
Strumite(inf)
Hemoragice
Compresiuni
Malignizare

Question 14

Sd Demons-Meigs

Answer 14

Tumora tiroidian ovariana

Ascita, Hidrotorax, Tumora Ovar

Question 15

Medicatie Gusa

Answer 15

Profilactic:
chimioprofilaxia cu iod
alimentatie
ameliorare cond viata

Medical
hormoni
solutie Lugol

Chirurgical:
(Esec medicatie, volum mare, nodulare, ectopice, hiperf, compresive, neuropate)

Tiroidecromie subtotala
Lobectomie
Enucleere chistului

Question 16

Mixedem clinic:

Answer 16

Tulburati trofice (edeme, par friabil, luna plina)

Nervoase (bradipsihie, motorii, hipoacuzie)

Endocrine (hipogonad. hipoinsulin. ,insuf.suprarenaliana, ovariana, tetanus)

CV (bradicardie, EKG)

Digestive (atonii cai biliare, tub digestiv)

Metabolice: scazut

Tulb dezv somatica

Question 17

Forme clinice de mixedem

Answer 17

Congenital: nanism + cretinism
Juvenil
Adult post tiroidect.
Frust-> debut rapid cu semne

Question 18

Etiologie hipertiroidii

Answer 18

Frecv la femeie > 50 ani, pubertate, sarcina, menopauza

Factori det: traume psihice, infectii, intoxicatii, tumori

Factori fav: stres, surmenaj, leziuni, snc labil

Question 19

Teorii hipertiroidie

Answer 19

1. Teoria cortico-diencefalo-hipof.
2. Teoria autoimuna
3. Teoria evolutiei stadiale

Question 20

Clinica hipertiroidii

Answer 20

Sindrom central cortico diencefalo hipofizo tiroidian:

agitatie, nervozitate, insomnii, lab psihica

hipersudoratie, dermografism( semn maranon), constrictie toracica, tremor

Oculare: exoftalmie, privire stralucitoare, def covergenta, clipure frecv, pigm periorb

Hipertrofia apare tardiv

Sindrom periferic:

CV: tahic, palpitatie, aritmii, ic
Scadere ponderala
Termofobie
Tulb trofice

Question 21

Paraclinice hipertiroidie

Answer 21

Iodocaptare ridicata
T3 T4 crescute
Clearence iod crescut
Scintigrafie-hipercapt neomogena
Ekg
Colesterol scz

Question 22

Forme clinice hipertiroidii

Answer 22

1. Hipertiroidia pura primara
   (Tireotoxicoza)
   Hiperfunctie=>gusa
2. Adenom toxic tiroidian
   (Plummer)
   -hiperfunctie fara particip centrala
   Scintigrf: adenom hupersecretant in glanda hipofunctionala, fara exoftalmie
3. Gusa exoftalmica
   (Basedow - Graves)
   Hipertrofie cu implicarea axului talamo hipofizar
4. Gusa hipertiroidizanta
   (boala Basedow)
   Hipertiroidie secundara

Question 23

Complicatii hipertiroidie

Answer 23

Cardiopatia hipertensiva
Hepatoza tireotoxica
Diabet tiroidian
TBC pulmonar

Question 24

Contrindicatii chirurgie tiroida

Answer 24

Forme centrale
Boli grave
Sub 16 ani
Tulb psihice
Fat gusa

Question 25

Tiroidite cronice

Answer 25

1. Limfomatoasa (Hashimoto) -femei tinere -hipertrofie ferma, asim, difuza -debut insidios,hipertrof, disfun. -glanda marita, vagi dureri, displazie, dispnee, adenopatii -paraclinic alfa2, ac anti, iodocaptare mare, punctie diagn 2. Fibromatoasa (Riedel) -femei varsta medie -tesut fibros si infiltrat inflamator ce se extinde -debut insidios -glanda dura, fixa, semne compresiune, fara adenopatie, -stare gen buna -iodocaptare normala -evolutie in 12 ani asfixie

Question 26

Etiologie cancere tiroidiene

Answer 26

-carenta iod -antitiroidiene de sinteza -iradieri -noduli sau adenoame

Question 27

Cancere tiroidiene

Answer 27

Carcinom: Vezicular Folicular Nodular Spinocelular Anaplazic Sarcom Fibrosarcom Limfosarcom Limfom mailgn Carcinosarcom Teratom Metastaze Forme: -acute -lente -schiroase -aberante