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Glanda tiroidaGlanda tiroida
GusaGusa
Istoria chirurgiei tiroidieneIstoria chirurgiei tiroidiene
• Claudius Galen (129 - 199);Claudius Galen (129 - 199);
• Andreas Vesalius (1514 -Andreas Vesalius (1514 -
1564) - prima descriere a1564) - prima descriere a
anatomiei tiroidiene;anatomiei tiroidiene;
• Th. Warton 1656Th. Warton 1656
• R.J. Graves (1796 - 1853);R.J. Graves (1796 - 1853);
• K.A. von Basedow (1799 -K.A. von Basedow (1799 -
1854);1854);
• Th. Kocher (1883) -Th. Kocher (1883) -
recomanda tiroidectomierecomanda tiroidectomie
subtotala; Premiu Nobelsubtotala; Premiu Nobel
• C.I. Parhon, St. Milcu, I.C.I. Parhon, St. Milcu, I.
Muresan.Muresan.
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Anatomia tiroideiAnatomia tiroidei
Fiziologia glandei tiroideFiziologia glandei tiroide
• BiosintezaBiosinteza
hormonalahormonala
Fiziologia glandei tiroideFiziologia glandei tiroide
• SecretiaSecretia
hormonalahormonala
Fiziologia glandei tiroideFiziologia glandei tiroide
Fiziologia glandei tiroideFiziologia glandei tiroide
• Controlul secretieiControlul secretiei
hormonalehormonale
Mecanism de actiune alMecanism de actiune al
hormonului tiroidianhormonului tiroidian
• Nivel de actiune:Nivel de actiune:
– nuclearnuclear
– mitocondrialmitocondrial
– membrana celularamembrana celulara
• Efecte metabolice:Efecte metabolice:
– calorigenezacalorigeneza
– metabolism proteic, glucidic si lipidicmetabolism proteic, glucidic si lipidic
GusaGusa
Gusa difuzaGusa 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 nodularaGusa nodulara •Uni sau plurinodularaUni sau plurinodulara
DefinitieDefinitie
ClasificareClasificare
EpidemiologiaEpidemiologia
• 5 % din populatie5 % din populatie
• Zone endemiceZone endemice
EtiologiaEtiologia
• Deficitul de iod cel mai important factorDeficitul de iod cel mai important factor
• Alti factori: exces de iod, minerale,Alti factori: exces de iod, minerale,
defecte congenitaledefecte congenitale
PatogeniePatogenie
Hiperplazia tiroidiana prod. sub act. fact deHiperplazia tiroidiana prod. sub act. fact de
stimulare a cresterii tiroidienestimulare a cresterii tiroidiene
Factori extratiroidieni:Factori extratiroidieni:
• Deficit de iod - TSH - hiperplazie tiroidianaDeficit de iod - TSH - hiperplazie tiroidiana
• GSI (thyroid – growth – stimulating –GSI (thyroid – growth – stimulating –
immunoglobulin)immunoglobulin)
Factori intratiroidieni (citokine)Factori intratiroidieni (citokine)
Heterogenitatea morfologica si functionalaHeterogenitatea morfologica si functionala
MorfopatologieMorfopatologie
• Difuza:Difuza:
– microfolicularamicrofoliculara
– macrofolicularamacrofoliculara
• Nodulara:Nodulara:
– uninodularauninodulara
– multinodularamultinodulara
• Modificari aleModificari ale
tesutului conjunctiv:tesutului conjunctiv:
– fibroasefibroase
– calcificatecalcificate
MorfopatologieMorfopatologie
• Gusa adenochistica
MorfopatologieMorfopatologie
Adenomul tiroidian
Tiroida normala
Studiu clinicStudiu clinic
• AnamnezaAnamneza
• Examen clinicExamen clinic
• Clasificare clinica:Clasificare clinica:
– 00
– IaIa
– IbIb
– IIII
– IIIIII
Examenul clinicExamenul clinic
Examen paraclinicExamen paraclinic
MorfologiceMorfologice
• RadiografiaRadiografia
cervicalacervicala
Examen paraclinicExamen paraclinic
MorfologiceMorfologice
RadiografiaRadiografia
toracicatoracica
Examen paraclinicExamen paraclinic
MorfologiceMorfologice
• EcografiaEcografia
Examen paraclinicExamen paraclinic
MorfologiceMorfologice
• ScintigrafiaScintigrafia
tiroidianatiroidiana
Examen paraclinicExamen paraclinic
MorfologiceMorfologice
• Computer tomografComputer tomograf
• RMNRMN
• Punctia tiroidiana cu ac subtirePunctia tiroidiana cu ac subtire
• Ex ORLEx ORL
Examen paraclinicExamen paraclinic
Computer tomografComputer tomograf
Examen paraclinicExamen paraclinic
Computer tomografComputer tomograf
Examen paraclinicExamen paraclinic
FunctionaleFunctionale
• TSHTSH
• fT4, fT3, T4, T3fT4, fT3, T4, T3
• Teste de stimulareTeste de stimulare
• Anticorpi antitiroidieniAnticorpi antitiroidieni
Diagnosticul diferentialDiagnosticul diferential
Alte afectiuni tiroidiene:Alte afectiuni tiroidiene:
• Cancerul tiroidianCancerul tiroidian
• TiroiditeleTiroiditele
• HipertiroidiileHipertiroidiile
Alte tumori cervicaleAlte tumori cervicale
ComplicatiiComplicatii
• CompresiuniCompresiuni
• HipotiroidieHipotiroidie
• HipertiroidieHipertiroidie
• MalignizareMalignizare
Forme cliniceForme clinice
• EtiologiceEtiologice
• Localizare:Localizare:
– retrosternalaretrosternala
– mediastinalamediastinala
– lingualalinguala
– esofagianaesofagiana
– trahealatraheala
– ovarianaovariana
TratamentTratament
• ProfilacticProfilactic
• MedicalMedical
• ChirurgicalChirurgical
Tratament chirurgicalTratament chirurgical
Indicatii:Indicatii:
– Gusi voluminoaseGusi voluminoase
– Gusi compresiveGusi compresive
– Gusi uninodulareGusi uninodulare
– Gusi maligne sau cu suspiciune deGusi maligne sau cu suspiciune de
malignizaremalignizare
– Gusi retrosternaleGusi retrosternale
– Gusi ectopiceGusi ectopice
– Imposibilitatea tratamentului medicalImposibilitatea tratamentului medical
– Ratiuni esteticeRatiuni estetice
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
IncizieIncizie
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Tratament ChirurgicalTratament Chirurgical
Tiroidectomia subtotalaTiroidectomia subtotala
Complicatii postoperatoriiComplicatii postoperatorii
• Hemoragii
• Leziuni ale nervului recurent
• Insuficienta paratiroidiana
• Hipotiroidie
• Recidiva

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