Cov kab mob thyroid (cov thyroid caj pas) nyob qhov chaw ua tom qab ntshav qab zib ntawm cov kab mob endocrine. Lub tswv yim ntawm goiter yog sib sau ua ke, vim hais tias nws yog tag nrho cov pab pawg neeg ntawm cov kab mob nrog ib tug nce nyob rau hauv loj, tab sis nrog txawv etiologies. Kev loj hlob ntawm lub caj pas (struma) tuaj yeem pom ob qho tib si nrog nce thiab txo kev ua haujlwm.
Yuav ua li cas kom paub qhov txawv ntawm goiter ntawm lwm qhov loj? Thaum nqos, nws yuav nce thiab nqis.
Goiter nrog hyperthyroidism tshwm sim 10 zaug ntau dua li cov thyroid. Nws yog ib txwm tsis tu ncua thiab yeej tsis yaj ntawm nws tus kheej. Pathology hauv cov poj niam tshwm sim yuav luag 10 npaug ntau dua li cov txiv neej, feem ntau hauv 20-40 xyoo. Qhov no yog vim lub fact tias nyob rau hauv kev ua hauj lwm ntawm cov txiv neej lub cev muaj ntau ntau stability. Thiab lub cev ntawm cov poj niam tsis tu ncua hloov hormonal: menarche, gestation, yug me nyuam, lactation, menopause…
Lo lus nws tus kheej hais txog qhov zoo sib xws ntawm goiter nrog cov noog. Lawv muaj qhov tshwj xeeb nthuav ntawm txoj hlab pas, uas cov zaub mov accumulates, thiab lub caj dab nthuav dav hauv qhov chaw no.(piv txwv li, pelicans). Tsis muaj dab tsi accumulates hauv cov thyroid caj pas, tab sis cov ntaub so ntswg loj hlob. Lub sij hawm tau qhia los ntawm Swiss naturalist A. Haller nyob rau hauv lub xyoo pua 18th.
Qhov tseem ceeb ntawm tus kab mob
Kev hloov pauv hauv cov thyroid caj pas nrog goiter tsis yog mob hauv qhov xwm txheej thiab tsis cuam tshuam nrog cov qog. Qhov ntim ntawm cov thyroid caj pas rau cov poj niam yog 15-20 ml, hauv cov txiv neej - 18-25 ml. Ib qho dhau ntawm cov nuj nqis no suav tias yog struma. Cov thyroid caj pas loj hlob thoob plaws hauv lub hnub nyoog laus, tom qab ntawd stabilizes, thiab maj mam pib atrophy thaum laus.
Type of goiter
Nws tuaj yeem tshwm sim thiab muaj nyob ua tus kab mob tseem ceeb, nws tuaj yeem ua tau thib ob, uas yog, tawm tsam keeb kwm ntawm ib qho uas twb muaj lawm.
Raws li kev ua haujlwm, goiter tuaj yeem nrog hypo-, hyperfunction ntawm lub caj pas lossis euthyroid. Kuj tseem muaj cov kab mob goiter endemic (nrog iodine deficiency) thiab sporadic. Hauv kev xaiv thib ob, qhov laj thawj tseem tsis meej.
Raws li cov morphology, goiter yog nodular, diffuse thiab sib tov.
Yog tias tsuas muaj 2 nodes nyob rau hauv cov thyroid caj pas, nws twb xam tau tias yog multinodular. Cov kab mob no tshwm sim hauv txhua tus neeg mob thib ob.
Nrog diffuse goiter, lub caj pas yog uniformly hypertrophied, nrog rau qhov tsis sib xws, cov nodes feem ntau yog culprits. Hauv qhov kawg, theem ntawm cov tshuaj hormones yog qhov qub.
Raws li qhov cuam tshuam ntawm cov tshuaj hormones ntawm lub cev goiter tau muab faib ua tshuaj lom thiab tsis muaj tshuaj lom. Thawj yog tus cwj pwm los ntawm kev cuam tshuam rau tag nrho lub cev.
Factors
Tag nrho cov xwm txheej predisposing yog exogenous thiab endogenous.
Exogenous:
- tsis muaj iodine, tsis muaj selenium, zinc thiab molybdenum;
- phem ecology, hluav taws xob, ultraviolet;
- kev mob nkeeg;
- noj tshuaj uas thaiv kev thauj khoom iodine;
- tsis tsaug zog;
- tus cwj pwm phem;
- kab mob;
- hypothermia thiab vasospasm nrog lawv;
- kev tawm dag zog.
Endogenous:
- gender;
- txo qis kev tiv thaiv;
- kev nyuaj siab thiab ntxhov siab ntau dhau;
- hormone imbalance;
- cov txheej txheem autoimmune;
- kab mob hauv caj pas nws tus kheej (mob, tsim, ua haujlwm tsis zoo nyob rau hauv daim ntawv ntawm ntau ntxiv ntawm colloid);
- obesity;
- lwm cov kab mob endocrine;
- noj tsis txaus thiab noj zaub mov nrog nitrates thiab tshuaj tua kab;
- pathologies hauv cov qog parathyroid lossis pancreas;
- ua haujlwm hauv kev lag luam tshuaj.
Kev loj hlob ntawm goiter ntawm 2nd degree ntawm cov thyroid caj pas cuam tshuam los ntawm cov dej muaj pes tsawg leeg - muaj feem pua ntawm calcium ntsev, urochrome, nitrates, thiab lwm yam hauv nws. kev nqus ntawm iodine. Nrog nws qhov tsis txaus, diffuse goiter tshwm hauv 90% ntawm cov neeg mob.
Kev faib cov goiter los ntawm qib
Muaj ob qhov kev faib tawm. Txij li thaum 1955, gradation ntawm O. V. Nikolaev tau siv thiab xyaum mus txog rau thaum lub advent ntawm ultrasound. Txij li xyoo 1992, WHO kev faib tawm tau siv rau txawv teb chaws.
Nikolaev qhov kev gradation tseem siv niaj hnub no vim nws qhov kev ua tau zoo, cov ntsiab lus thiab kev xaiv raug ntawm tacticskev kho mob. Nws cuam tshuam nrog 6 degrees ntawm goiter:
- 0 degree - tsis muaj chaw kho mob, tsuas yog hloov pauv hauv kev tshuaj ntsuam;
- 1 degree - tsis muaj qhov pom kev thiab kho mob hloov pauv, lub pob tsuas pom tau los ntawm kev soj ntsuam;
- 2 degree ntawm goiter ntawm cov thyroid caj pas - tag nrho cov thyroid caj pas yog palpated kiag li thiab lub isthmus yog pom thaum nqos;
- 3 degree - pem hauv ntej ntawm caj dab tau hloov pom;
- 4 degree - caj dab tuab thiab dai goiter;
- 5 degree - goiter loj heev, muaj tus mob compression, tsawg heev.
Hauv qhov systematization ntawm WHO, muaj 3 theem ntawm cov thyroid o. Yog li ntawd, tag nrho cov qib tom qab 2 tau muab faib ua 2, uas ua rau nws nyuaj rau kev kuaj mob thiab xaiv kev kho mob. Tsis muaj qhov sib txawv meej.
Hauv kev faib tawm no, muaj 3 qib:
- 0 degree - tsis muaj qhov pom kev hloov pauv, tab sis lub caj pas palpable. Nws cov shares tsis pub tshaj qhov loj ntawm qhov distal phalanx ntawm tus neeg mob tus ntiv tes xoo. Cov cheeb tsam ntawm hypertrophy muaj nyob rau ntawm biopsy.
- 1 degree - qhov loj ntawm cov thyroid lobes loj dua cov phalanges distal. Lawv tsuas yog txiav txim los ntawm kev soj ntsuam, tsis pom qhov muag.
- 2 degree ntawm goiter - lub caj dab yog deformed, thiab tus neeg mob tuaj yeem hnov qhov kev hloov hauv caj pas ntawm nws tus kheej.
DTZ
Diffuse toxic goiter ntawm cov thyroid caj pas ntawm 2nd degree (DTG) tshwm sim ntau zaus ntawm 20 mus rau 40 xyoo. Qhov cuam tshuam ntawm nodes yog tshuaj lom. Hauv 85% ntawm cov neeg mob, DTG yog nrog los ntawm hyperfunction ntawm lub caj pas nyob rau hauv daim ntawv ntawm thyrotoxicosis.
Txoj kev txhim kho ntawm tus kab mob goiter yog qhov tsis txausiodine, uas cov thyroid caj pas siv los tsim nws cov tshuaj hormones, nws pib mus nrhiav thiab nqus nws (tsawg kawg yog dab tsi tau txais me ntsis). Rau lub hom phiaj no, nws yuav tsum tau ua kom nws loj. Nov yog hom kev hloov pauv ntawm lub caj pas.
Ntxiv rau qhov txheej txheem no, diffuse toxic goiter ntawm 2nd degree ntawm cov thyroid caj pas feem ntau tshwm sim los ntawm kev tsim cov noob hloov pauv thiab cov txheej txheem autoimmune. Nws tuaj yeem txhim kho los ntawm kev noj cov tshuaj levothyroxine (cov tshuaj thyrotoxicosis).
Diffuse goiter ntawm cov thyroid caj pas ntawm 2nd degree lossis hyperthyroidism yog kab mob ntawm cov neeg nyob hauv thaj chaw uas tsis muaj iodine.
daim duab kho mob ntawm goiter nrog hyperfunction
Nws tuaj yeem ua tau los yog nodular, tab sis ib txwm muaj tshuaj lom. Txhua qhov tshwm sim ntawm cov kab mob toxic goiter ntawm cov thyroid caj pas ntawm qib 2 yog txuam nrog kev ua kom nrawm ntawm cov metabolism.
Hloov pauv hauv CNS:
- Kuv muaj kev kub ntxhov thiab fussiness;
- chim siab thiab insomnia;
- tendon reflexes nce, leeg tsis muaj zog;
- adynamia thiab osteopenia.
Hloov pauv hauv cov hlab plawv:
- palpitations (mem tes 120-130);
- nce siab, jugular pulsation;
- atrial fibrillation, ua tsis taus pa thiab kev loj hlob ntawm insufficiency;
- nrog thrombosis;
- myocardial dystrophy.
Pab plab:
- qab los noj mov ntxiv thaum poob ceeb thawj;
- nce metabolism ua rau sai duaplab hnyuv motility, uas ua rau raws plab;
- kub intolerance, subfebrile mob, hyperhidrosis, tas li hnov kub;
- tom qab cov tsos mob ntawm exophthalmos yuav tsum koom nrog, daim tawv muag yuav tsum kaw tag nrho, vim muaj lwm cov tsos mob ntawm qhov muag ntxiv (tseem muaj 10 ntawm lawv);
- conjunctivitis thiab mob ntawm qhov muag tshwm sim, pom kev tsis zoo;
- cov tsos mob ntawm Marie yog yam ntxwv (kev tshee ntawm cov ntiv tes lossis ntiv taw - qhia kev puas tsuaj rau lub paj hlwb peripheral);
- telegraph tus tsos mob - tshee ntawm lub cev tag nrho.
plaub hau thiab tawv nqaij:
- alopecia, brittleness thiab puas rau cov rau tes;
- daim tawv nqaij kub thiab velvety;
- tawv nqaij tawv nqaij tawv tawv.
Kev tsim kev puas tsuaj rau menyuam:
- voj voog mob, zes qe menyuam tsis ua haujlwm;
- txo qis potency thiab erection ntawm txiv neej, gynecomastia;
- raum yuav cuam tshuam ua rau lub raum tsis ua haujlwm.
Mechanical tsos mob:
- pem hauv ntej ntawm caj dab mob thiab loj;
- suab nrov;
- xav khaus thiab pob hauv caj pas;
- ua pa luv thiab hnoos qhuav;
- kiv taub hau.
Tshuaj lom diffuse-nodular lossis multinodular goiter ntawm cov thyroid caj pas ntawm qib 2 yog tus cwj pwm los ntawm kev loj hlob sai ntawm cov nodes mus txog qhov loj ntawm ntau tshaj 3 cm.
Hauv cov mob hnyav tom qab qib 3, kev kho mob tsuas yog phais xwb. Qhov loj ntawm cov thyroid caj pas raug tshem tawm, tsuas yog 5 g tsuas yog rau nws ua haujlwm, thiab tsis tas yuav haus cov tshuaj hormones rau lub neej.
Tab sisKoj yuav tsum paub tias kev ua haujlwm ntawm diffuse nodular goiter ntawm cov thyroid caj pas ntawm qib 2 tsis tau lees tias qhov tsis suav nrog kev rov qab los, uas tuaj yeem tshwm sim hauv 10% ntawm cov neeg mob.
Goiter nrog hypothyroidism
Kev kuaj mob tsawg dua. Ntawm 2nd degree, hypertrophy tsis sib xws, asymmetrical. Cov tsos mob tsis tshwm sim tam sim ntawd, tau ntau xyoo tsis muaj chaw kho mob.
Nrog hypothyroid goiter ntawm cov thyroid caj pas ntawm 2nd degree, cov tsos mob thiab tshwm sim yog vim muaj kev poob qis hauv cov metabolism:
- nce qhov hnyav nce nyob rau tib lub sijhawm nrog txo qis qab los;
- qaug zog, qhov txias tsis tu ncua vim muaj kev nkag siab ntau ntxiv rau qhov txias;
- pom thiab hnov tsis hnov lus;
- cephalgia;
- lethargy, qaug zog thiab qaug zog;
- slows hais lus thiab txav, nco tsis;
- impotence nyob rau hauv cov txiv neej thiab tsis muaj libido nyob rau hauv cov poj niam, infertility thiab nchuav menyuam;
- daim tawv nqaij yog flabby, qhuav, lub teeb me ntsis tshwm rau lawv vim qhov txo qis hauv melanin ntau lawm;
- plaub hau poob;
- ntsia hlau tawg;
- caj npab thiab ntsej muag o - lub puab tsaig tuab, qhov muag nqaim;
- tus nplaig thiab daim di ncauj yog tuab;
- ntawm qhov chaw ntawm tus nplaig - luam tawm ntawm cov hniav;
- qeeb metabolism ua rau cem quav thiab flatulence, xeev siab;
- bradycardia thiab hypotension;
Nyob rau hauv cov xwm txheej hnyav, o tau pom thoob plaws hauv lub cev - myxedema. Thaum nruab hnub koj xav pw, hmo ntuj - tsis tsaug zog. Lub siab yog kev nyuaj siab. Hypothyroidism hauv cov menyuam yaus hem nrog kev puas hlwb.
YEuthyroid goiter
Nws tuaj yeem tshwm sim thaumtxhua yam pathology ntawm lub caj pas. Nws ua 50-70% ntawm tag nrho cov kev mus ntsib kws kho mob endocrinologist. Nrog nodular goiter, lub caj pas muaj ib los yog ntau dua nodes. Cov tshuaj hormones tsim tawm ib txwm, cov metabolism hauv ib txwm muaj, tab sis qhov txawv txav tuaj yeem pom nyob rau hauv cov ntaub so ntswg ntawm caj pas. Lub tsev kho mob nthuav tawm cov tsos mob tseem ceeb ntawm cov neeg kho tshuab.
Cov cim qhia ntawm nodular colloid goiter ntawm cov thyroid caj pas ntawm qib 2 nrog cov tshuaj hormones ib txwm muaj raws li hauv qab no:
- thaum lub pob qhov loj dua 3 cm, muaj qhov tsis xis nyob hauv caj dab;
- dysphagia;
- mob caj pas;
- ua pa luv thiab ua tsis taus pa;
- paroxysmal hnoos qhuav;
- xav txog lub cev txawv teb chaws hauv caj pas;
- hloov lub suab ntawm lub suab vim yog lub suab ntawm lub suab;
- mob thiab hloov pauv ntawm caj dab.
Tsis muaj poj niam txiv neej sib txawv. Colloidal goiter yeej tsis rov tsim dua.
Nodular goiter ntawm thyroid caj pas
Nodular colloid goiter account rau 90% ntawm cov tsos mob ntawm cov qog hauv cov thyroid caj pas. Nws muaj thyroglobulin. Nrog nodular goiter, cov follicles pib loj hlob. Qhov no yog qhia nyob rau hauv ib tug nce nyob rau hauv ib tug colloid nyob rau hauv lawv - ib tug viscous kua, vim lub npe tshwm sim.
Nrog cov kab mob goiter ntawm cov thyroid caj pas, qhov concentration ntawm T3 (triiodothyronine) nce, qhov no yog muab los ntawm overgrown follicles uas tsim cov tshuaj hormones. Cov ua rau goiter yog txuam nrog tsis muaj iodine. Colloidal goiter ntawm cov thyroid caj pas ntawm qib 2 kuj tseem tuaj yeem nrog los ntawm kev txo qis lossis nce hauv kev tsim cov thyroid hormones thiab cov tsos mob sib xws tau piav qhia saum toj no.
Diagnosis
Dhau li ntawm kev kuaj dav dav rau tus kws kho mobyuav tsum palpate caj pas.
Feem ntau, kev kuaj mob ntawm qib 2 thyroid goiter txhais tau tias:
- Ultrasound ntawm thyroid caj pas;
- lub hauv siab X-ray;
- gland scintigraphy;
- ntau tsawg zaus MRI lossis CT;
- ntshav rau TSH, T3 yog ib qho kev sim yooj yim tshaj plaws thiab paub ntau tshaj;
- kev txiav txim siab ntawm cov tshuaj tiv thaiv ATPO;
- FNA - koob tshuaj biopsy zoo.
Ntau zaus hauv kev xyaum, ultrasound thiab ntshav cov tshuaj hormones txaus los kuaj xyuas.
Kev nyuaj siab
Goiter tsim tsis tsuas yog cov tshuaj pleev ib ce, nws ua rau mob nrog kev loj hlob ntawm arrhythmias thiab lub plawv tsis ua hauj lwm, ua rau kom cov ntshav txhaws, ua rau kev txawj ntse thiab mnestic mob, hepatosis. Tej zaum yuav muaj hemorrhage nyob rau hauv parenchyma ntawm lub caj pas nws tus kheej, nws o (strumitis).
Cov teeb meem hnyav tshaj plaws yog thyrotoxic ntsoog, uas feem ntau ua rau tuag taus. Qhov zaus ntawm qhov tshwm sim yog 20% nrog thyrotoxicosis. Tsis tshua muaj heev, malignancy ntawm cov nodes yog ua tau.
ntsuas ntsuas
Cov tsos mob thiab kev kho mob ntawm qib 2 cov thyroid goiter ib txwm muaj kev cuam tshuam, piv txwv li kev kho mob tactics nyob ntawm qhov tshwm sim thawj zaug, qib ntawm goiter, hnub nyoog, thiab lwm yam.
Nrog goiter ntawm 2nd degree, tshuaj tiv thaiv ntshav siab, tshuaj sedatives. Txhawm rau kom normalize cov thyroid hormones, thyreostatics yog siv. Muaj ntau ntawm lawv - "Mitezol", "Tyrozol", "Carbimazole", "Tiamazol", "Propicil" thiab lwm yam."Mercazolil" vim tias nws muab cov txiaj ntsig hauv txhua qib ntawm hyperthyroidism. Qhov koob tshuaj yog tus kheej. Kev kho mob yog los ntawm 3 lub hlis mus rau rau lub hlis.
Yuav ua li cas kho qib 2 thyroid goiter?
Kev kho mob kuj nyob ntawm qhov mob hnyav ntawm cov tsos mob. Yog tias tsuas yog nce me ntsis, ces koj tuaj yeem txwv koj tus kheej rau kev npaj iodine thiab noj zaub mov. Nrog rau kev ua haujlwm tsis zoo, cov tshuaj hormones hluavtaws tau sau tseg rau lub neej.
Yog tias kev kho mob ntawm qib 2 thyroid goiter tsis ua haujlwm, lub cev raug tshem tawm sai li sai tau raws li kev kho tshuaj hormone.
Nrog rau qhov tshwm sim ntawm goiter xws li arrhythmias, beta-blockers ("Anaprilin") raug tshuaj. Cov tshuaj no txo qhov zaus ntawm tachycardia, txo cov feeb ntim ntawm cov ntshav thiab siab.
Cov kab mob ntawm lub qhov muag tau kho nrog corticosteroids, feem ntau nrog kev kawm ntawm "Prednisolone" nrog kev txo qis qis. Hoob - 2-3 lub hlis. Cov txiaj ntsig tau sau tseg yog tias kev kho mob ntawm qhov muag pom tshwm sim ua ntej 6 lub hlis txij li qhov pib ntawm lawv qhov pib. Txwv tsis pub, cov ntaub so ntswg nyob ib ncig ntawm lub qhov muag yuav txhim kho thiab cov pob txha yuav tsum tau phais.
kev kho mob radical
Kev ua haujlwm tsuas yog tom qab qhov kev txheeb xyuas qhov qub. Qhov kev cuam tshuam yuav tshwm sim hauv qab tshuaj loog. Ib feem me me ntawm lub caj pas yog sab laug, uas yuav siv tag nrho cov haujlwm lossis tag nrho lub cev raug tshem tawm.
Kev kho kom rov zoo yog ob peb lub lis piam. Nodular toxic goiter zoo heevqiv nws tus kheej rau RJT - kev siv xov tooj cua iodine. Radioiodine muaj peev xwm ua kom puas cov ntaub so ntswg (follicular cells) ntawm cov thyroid caj pas. Nrog rau txoj kev koob tshuaj, nodule loj tuaj yeem txo tau txog li 80%.
Kev Tiv Thaiv
Kab mob goiter yog qhov yooj yim los tiv thaiv. Txoj kev yooj yim tshaj plaws yog iodized ntsev. Nws ntxiv tom qab ua noj.
Ib qho chaw tseem ceeb hauv kev tiv thaiv yog muab rau kev noj qab haus huv. Nws yog ib qho tsim nyog los tshem tawm kev ntxhov siab, kev ua haujlwm dhau los, txhawm rau tsim kom muaj khoom noj khoom haus zoo. Yuav tsum muaj zog tiv thaiv kab mob.
Nrog kev ua tsis zoo, ib tus neeg yuav tsum tau sau npe nrog tus kws kho mob endocrinologist, txawm tias tsis muaj cov tsos mob ntawm qhov txhab. Kev ntsuam xyuas tau ua txhua 3-4 lub hlis.
Nyob rau hauv lub xub ntiag ntawm pathology, cov neeg mob yuav tsum tiv thaiv lawv tus kheej los ntawm kev ntxhov siab ntawm txhua yam: nws yog nruj me ntsis txwv tsis pub ncuav dej txias (tsuas yog sov), sib piv cov da dej, kho av nkos, hnyav lub cev. Tag nrho cov txheej txheem no muaj kev ntxhov siab rau lub cev, thiab qhov xwm txheej ntawm cov thyroid caj pas tsuas yog zuj zus. Rau tib lub laj thawj, kev mus ncig ntev thiab kev hloov pauv hauv thaj chaw huab cua raug txwv.
