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2014, vol. 39, br. 4, str. 184-192
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Veličina strume kao parametar za predviđanje remisije kod pacijenata sa Grejvsovom bolešću lečenih medikamentnom tirosupresivnom terapijom
Goiter size as a parameter for predicting remission in patients suffering from Graves disease treated by thyrosupressive drug therapy
aOdeljenje interne medicine, Zdravstveni centar, Zaječar bSlužba nuklearne medicine, Zdravstveni centar, Zaječar cOdeljenje neurologije, Zdravstveni centar, Zaječar dDnevna bolnica za hemioterapiju, Zdravstveni centar, Vranje
e-adresa: lukaal@ptt.rs
Sažetak
Grejvsova bolest definiše se kao hipertireoidizam sa difuznom strumom nastalom zbog imunskih poremećaja. Napori da se identifikuju činioci koji bi mogli da ukažu na verovatnoću postizanja remisije, odnosno pojave recidiva po prekidu medikamentne tirosupresivne terapije neprekidno traju. Izveštaji o postignutoj dugotrajnoj remisiji kreću se od 14 do 80% lečenih, a ukupna stopa recidiva po prekidu lečenja je 30- 50%. Utvrđivanje ranih prognostičkih faktora za ishod medikamentne tirosupresivne terapije moglo bi da omogući razlikovanje pacijenata koji reaguju i koji ne reaguju na terapiju, i pravovremeni izbor ablativne terapije. Cilj istraživanja je bio da se utvrdi uticaj veličine strume na predviđanje nastanka remisije tokom medikamentne tirosupresivne terapije. Istraživanje je sprovedeno u vidu prospektivne studije uključivši 106 uzastopnih pacijenata sa novootkrivenim autoimunim hipertireoidizmom, kojima je započeta medikamentna tirosupresivna terapija. Po postavljanju dijagnoze bolesti, nakon anamnestičke, kliničke i biohemijske obrade na početku bolesti i 12 meseci po započinjanju medikamentne tirosupresivne terapije, praćeni su prisustvo i veličina strume, palpatorno i volumetrijski. Kod većine naših ispitanika (oko 90%), na početku bolesti struma je mala ili odsutna (gradus 0A, 0B, 0-I). Tokom MTT struktura ispitanika prema prisustvu i veličini strume se bitno ne menja. Prosečan volumen tireoidee na početku bolesti, kod naših ispitanika je oko 21 ml. Tokom MTT i dvanaest meseci po započinjanju MTT, nije primećena bitna promena u veličini tireoidee. Nije primećeno da postoji značajna razlika u prisustvu i veličini strume, bilo da je određivana palpacijom, bilo da je merena ehosonografski, između pacijenata u remisiji i onih koji nisu postigli remisiju. Rezultati ukazuju da prisustvo i veličina strume na početku bolesti, nemaju značaja za predviđanje remisije kod pacijenata sa Grejvsovom bolešću lečenih medikamentnom tirosupresivnom terapijom.
Abstract
Graves' disease is defined as hyperthyroidism with diffuse goiter caused by immune disorders. Efforts to identify factors that may indicate the likelihood of achieving remission or relapse upon cessation of thyrosupressive drug therapy are continuously ongoing. Reports on the achievement of long-term remission range between 14-80% in the treated, and the overall rate of recurrence after withdrawal of treatment is about 30- 50%. Determination of the early prognostic factors for the outcome of thyrosupressive drug therapy could allow the differentiation between patients who respond and do not respond to therapy and timely selection of ablative therapy. The aim of this study was to determine the effect of goiter size as a predictor of remission during thyrosupressive drug therapy. The study was conducted in a prospective manner including 106 consecutive patients with newly diagnosed autoimmune hyperethyroidism who were given thyrosupressive drug therapy. After the diagnosis of the disease by anamnestic, clinical and biochemical examination at the beginning and 12 months after the initiation of thyrosupressive drug therapy, the presence and goiter size were followed by palpation and by echosonographic volumetry. In the majority of the patients (90%) at the beginning of the disease goiter was small or absent (grade 0A, 0B, 0-I). During the MTT the presence and goiter size did not change significantly. The average thyroid volume at the beginning of the disease in our patients was about 21 ml. During MTT and twelve months after the start of MTT, significant changes in the size of thyroid were not observed. It was observed that there was no significant difference in the presence and goiter site, whether it was determined by palpation, or measured echosonographically among patients in remission, and in those who had no remission. The results indicate that the presence and goiter size at the onset of the disease are not relevant for the prediction of remission in patients with Graves' disease treated by the thyrosupressive drug therapy.
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