Pristup djetetu s tirotoksikozom
DOI:
https://doi.org/10.13112/pc.1234Ključne riječi:
Tirotoksikoza; Gravesova bolest; Hashimotova bolest; Antitiroidni lijekovi; Tirodektomija; Radioizotopi jodaSažetak
Tirotoksikoza je kliničko stanje nastalo kao rezultat djelovanja povišenih serumskih koncentracija hormona štitnjače. Hipertireoza se definira kao stanje povišene serumske koncentracije hormona štitnjače zbog njene povećane funkcije, povećanog stvaranja i lučenja hormona trijodtironina (T3) i tiroksina (T4). Svaka hipertireoza znači i tirotoksikozu, dok svaka tirotoksikoza ne mora biti posljedica hipertireoze.
Tirotoksikoza je uzrokovana različitim čimbenicima, a manifestira se šarolikim kliničkim znakovima hipermetaboličkog stanja. Primjeren terapijski pristup ovisi o uzrocima bolesti i bolesnikovom stanju te zahtijeva brzu i pravilnu dijagnostičku obradu. Ovaj članak iznosi pregled liječenja tirotoksikoze zasnovano na klinički utemeljenim podatcima. Pregledom literature, posebno različitih smjernica i drugih publiciranih materijala, služeći se PubMed-om, izdvojili smo podatke koje iznosimo u kritičkom tonu. Klinički opis uključuje početnu kliničku evaluaciju i dijagnostički pristup tirotoksikozi, uključujući subkliničku hipertireozu, Hashimotovu i Gravesovu bolest. Pristup Gravesovoj bolesti uključuje tirostatske lijekove, terapiju radioaktivnim jodom i operativno liječenje. Iznijeti ćemo više preporuka i zaključaka na utemeljenim kliničkim podatcima racionalnog, pouzdanog i optimalnog kliničkog pristupa oboljelima od tirotoksikoze. Odabir načina liječenja Gravesove bolesti složen je proces. Razgovor o prednostima i rizicima predloženih terapijskih mjera s bolesnikom i njegovim roditeljima je nužan. Preporučuje se poticati roditelje bolesnika s Gravesovom bolešću koji imaju malu mogućnost za postizanje remisije na bržu odluku o definitivnom liječenju.
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