Kirurško liječenje hipertireoze

master's thesis

• Title (english): Surgical treatment of hyperthyroidism
• Author: Matija Miškec
• Mentor: Vladimir Bedeković (mentor)
• Committee member: Livije Kalogjera (predsjednik povjerenstva)
• Committee member: Mirko Ivkić (član povjerenstva)
• Committee member: Vladimir Bedeković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Hipertireoza je sindrom koji obilježava povećana sinteza i lučenje tireoidnih hormona iz štitnjače. Ovo stanje dovodi do hipermetabolizma poznatog kao tireotoksikoza. Najčešći oblik hipertireoze je difuzna toksična struma (Gravesova ili Basedowljeva bolest). Drugi oblici hipertireoze uključuju toksičnu multinodularnu strumu i solitarni toksični čvor (toksični adenom), koji su također poznati kao Plummerova bolest. Liječenje hipertireoze se temelji na tri terapijske mogućnosti koje uključuju korištenje antitireoidnih lijekova, primjenu radioaktivnog joda te kirurške metode. Kirurško liječenje se primjenjuje tamo gdje bolest ne odgovara na druge oblike liječenja. Postoji nekoliko kirurških tehnika u liječenju hipertireoze. Lobektomija obuhvaća odstranjenje jednog režnja štitnjače, ponekad zajedno s isthmusom. Ovo je pretežno terapija izbora u liječenju solitarnih toksičnih čvorova. Nasuprot tome stoji totalna tireoidektomija koja podrazumijeva odstranjenje cijele štitne žlijezde. Nju smatramo kirurškom metodom izbora kod pacijenata s Gravesovom bolešću i toksičnom multinodularnom strumom. Ostale mogućnosti su subtotalna te gotovo totalna (near-total) tireoidektomija. Subtotalna tireoidektomija znači odstranjenje više od polovice oba režnja uključujući i isthmus. Gotovo totalna tireoidektomija je postupak pri kojem se odstranjuje jedan režanj i isthmus uz resekciju najmanje 90% drugog režnja. Ove se dvije kirurške metode, jednako kao i lobektomija, izvode s ciljem uspostave eutireoze bez potrebe za nadomjesnim liječenjem tiroksinom. Iako totalna tireoidektomija dovodi do hipotireoze i potrebe za doživotnim uzimanjem tiroksina, najčešće je korištena kirurška metoda zbog gotovo nikakve vjerojatnosti za povratak bolesti. Kirurški zahvati igraju važnu ulogu u liječenju hipertireoze pa bi se trebali smatrati sastavnim dijelom liječenja ovog stanja.

Abstract (english)

Hyperthyroidism is a syndrome characterized by the excess synthesis and secretion of thyroid hormones by the thyroid gland. This condition leads to the hypermetabolic condition known as thyrotoxicosis. The most common form of hyperthyroidism is diffuse toxic goiter (Graves or Basedow disease). Other forms include toxic multinodular goiter and solitary toxic nodule (toxic adenoma), which are also known as Plummer disease. The management of hyperthyroidism is based on three treatment modalities which include therapy with antithyroid medications, radioactive iodine, or surgical methods. Surgical intervention is warranted where the disease has proved refractory to other forms of management. There are several surgical techniques in the treatment of hyperthyroidism. Lobectomy involves removing one lobe of the thyroid gland, sometimes with the isthmus. This is predominantly the treatment of choice in the management of solitary toxic nodules. The opposite option is total thyroidectomy, which means removing all of the thyroid gland and is regarded as the surgical procedure of choice for Graves disease and toxic multi-nodular goiter. The other possibilities are subtotal thyroidectomy and near-total thyroidectomy. Subtotal thyroidectomy is removal of more than half of both lobes including the isthmus. Near-total thyroidectomy is a procedure where one lobe and the isthmus are removed with resection of at least 90% of the other lobe. These two surgical methods, as well as lobectomy, are performed with the aim to maintain euthyroidism without the need for thyroxine replacement. Although a total thyroidectomy leads to hypothyroidism and the need for lifelong thyroxine treatment, it is usually the preferred choice, because of almost no chance of disease relapse. Surgery plays an important role in the management of hyperthyroidism and therefore should be considered an integral component of treatment.

• Keywords: štitnjača; hipertireoza; liječenje
• Keywords (english): thyroid; hyperthyroidism; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:472008
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-03 09:33:08