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2013, vol. 38, br. 3, str. 133-141
Prediktori ishoda medikamentne tiropsupresivne terapije kod pacijenata sa Grejvsovom bolešću
aZdravstveni centar Zaječar, Odeljenje interne medicine, Zaječar
bZdravstveni centar Zaječar, Služba za nuklearnu medicinu, Zaječar
cZdravstveni centar Zaječar, Odeljenje neurologije, Zaječar
dBel Medic, Dom zdravlja, Beograd

e-adresalukaal@ptt.rs
Ključne reči: Grejvsova bolest; medikamentna tirosupresivna terapija; ishod; prediktivni faktori
Sažetak
Grejvsova bolest (GB) je najčešći uzrok hipertiroidizma izazvan cirkulišućim IgG antitelima koja aktiviraju TSH receptor (TRAb). Medikamentna tirosupresivna terapija (MTT) je inicijalna terapija GB, naročito kod mlađih osoba, i prva terapija izbora u Evropi. Po prekidu MTT, recidivi bolesti se najčešće ispoljavaju u toku 6 meseci po prekidu terapije, ali se mogu zapaziti i posle nekoliko godina. Ukupna stopa recidiva kod pacijenata sa GB lečenih MTT po prekidu lečenja je najčešće 30-50%. U pacijenata kod kojih dođe do recidiva bolesti po prekidu MTT treba razmotriti mogućnost upućivanja na operativno lečenje ili na terapiju radioaktivnim jodom. U brojnim istraživanjima prethodnih decenija intenzivno se tragalo za faktorima koji bi mogli predvideti ishod MTT. Ispitivan je pojedinačni ili udruženi uticaj pola, starosti, veličine strume, oftalmopatije, nivoa tiroidnih hormona, TRAb-a i drugih imunskih, biohemijskih i kliničkih parametara kao mogućih prediktora ishoda MTT. Utvrđivanje mogućih kliničkih i biohemijskih parametara tiroidnog statusa pacijenata sa GB, na osnovu kojih se može predvideti ishod medikamentne tirosupresivne terapije značajno je zbog mogućnosti da se, shodno njihovom nalazu, pravovremeno izabere neki od drugih vidova terapije, kao što su radiojodna terapija ili operativno lečenje. Rezultati većine istraživanja pokazuju da svaki pojedinačni parametar tiroidnog statusa na početku bolesti nije dovoljan prediktor ishoda, da se kombinacijom parametara postiže bolja predikcija ishoda, ali i da nema konsenzusa oko ranih prognostičkih parametara koji bi ukazivali na verovatnoću dugoročne stabilne remisije GB nakon MTT.
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O članku

jezik rada: srpski
vrsta rada: prikaz
objavljen u SCIndeksu: 12.02.2014.