Explorari in patologia tiroidianaBazaleTSHT4 / fT4T3 / fT3Metabolisme BazalGlucidic LipidicDozari hormonaleExplorare imagisticaRasunet perifericDinamiceTest TRHTest TSHRadioizotopicaEchografieCT, IRM

Ce explorari alegem?

SubiectFunctie tiroidiana posibilaTest sericEutiroidie clinicanodul solitartirotoxicozaTSHgusa multinodularatirotoxicozaTSHgusa difuzatirotoxicozaTSHEutiroidie clinica, boala netiroidianatirotoxicoza sau hipotiroidiesuspect tirotoxicozaTSH, FT4suspect hipotiroidieTSH, FT4Tirotoxicoza in tratamenttirotoxicoza, hipotiroidie, eutiroidieTSH, FT4Hipotiroidie in tratamenttirotoxicoza, hipotiroidie, eutiroidieTSH

Teste dinamieSupresie tiroidiana (Wermer)T3 100 /zi 7 zileNormal scade RIC cu 30%diagnosticarea adenomului "autonom", nedecompensatDecompensarea adenomuluidiferentierea intre o crestere a captarii produsa de un deficit de iod si cea determinata de hipertiroidieNormalizare RIC intr-un deficit iodat nemodificata in tirotoxicoza. Acest test este mult mai putin utilizat acum, cnd dozarea TSH sau testul la TRH pot da aceleasi informatii Stimulare cu TSHExogen (Querido)Endogen (Studer Wiss)

Markeri periferici

METABOLICIhipotiroidie hipertiroidiemetabolism bazalcolesterol total si HDLfibronectinaferitinaenzima de conversie a angiotensineiSHBG (sex-hormone binding globuline)osteocalcinahidroxiprolina urinarafosfataza alcalinacreatin fosfokinazamioglobina

Anticorpi

AUTOANTICORPANTIGENMETODA DE DOZAREAntitiroglobulinatiroglobulina- hemaglutinare- ELISA- RIAAntimicrosomaltiroperoxidaza- hemaglutinare- ELISA- RIAAnti-receptor TSHreceptorul TSH- stimulatori (TSAb)- cultura de tireocite umane sau FRTL5- teste biologice citochimice- determinarea receptorilor- inhibitori (TBAb)- inhibarea in vitro a efectelor TSH sau TSAb- determinarea receptorilorAnti T3 sau T4T3, T4- legarea antigenului purificat (T3, T4) marcat cu 125I de IgG in serul pacientuluiAnti TSHTSH- legarea 125I-TSH de IgG in serul pacientuluiTGI (Ig stimulatoare a cresterii tiroidei)necunoscut- biocitochimie- indicele de metamorfoza in celulele FRTL5

Ecografia tiroidiana - tehnica examinarii protocol talia glandeilatimealungimea grosimea ambilor lobieventual grosimea istmului daca acesta depaseste 1 cm, ecostructura de ansamblu a glandeivolumul, situarea si ecostructura eventualelor leziuni

Tiroida normalaSectiune transversalaSectiune longitudinalalLg

Scintigrama tiroidianaScintigrama normalaradioiodocaptare

Chart2

0000

208120.66

3818261.33

562740.52

7337.561.53

8044.5704

8057588

80602016

2

4

6

12

24

48

deficit iodat

eutiroidie

hipertiroidie

hipotiroidie

timp (ore)

captarea I-131 (%)

Deficit iodat

Hipotiroidie

Hipertiroidie

Eutiroidie

Sheet1

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cf163252.613.522.242.310.524824.04482.43.31.77.001282.94.5213.57220.573283.47152

se1281.63.70.82.462721.72.612.29844.761120.9311.4041412.083.4841.27712

am1214.46.7345.98882.15.92.214.1741660.162963.47337.1282.662.318.657655.78564.37736

im1251.83.91.65.840641.63.11.64.126729.967361.73.51.54.6411.52.11.21.96566.60663.36076

fm1611.83.326.17761.53.61.85.054411.2322.44.7211.73121.93.11.64.9004816.63168-5.39968

am1640.9512.34352.317.9420.2824.21.14.80483.35.32.522.73727.5418-7.2618

gf1301.63.61.75.091841.83.71.24.155849.2476823.21.54.9921.92.512.477.4621.78568

cg1171.23.21.12.196481.23.51.53.2765.472482.14.31.67.512961.63.112.579210.09216-4.61968

ga1282.34.61.68.802562.13.91.56.388215.190762.841.37.57122.13.71.45.6565613.227761.963

pn1551.94.62.29.9985624.92.412.230422.228961.84.32.18.452082.34.22.613.0603221.51240.71656

pi1351.641.65.324825.21.89.734415.05921.83.31.44.324321.42.912.11126.435528.62368

rc2132.65.72.821.577922.55.3320.6742.247923.25.62.220.500482.35.11.710.3693230.869811.37812

ul2311.24.51.54.212141.53.127.3321.63.51.44.07681.34.71.13.494927.57172-0.23972

bi2514.77.25.393.263044.97.24.582.5552175.8182466.64.286.48644.77.34.274.93304161.4194414.3988

dc1452.36.32.821.097442.46.52.822.713643.811042.45.72.819.918082.84.72.718.4766438.394725.41632

ri1611.631.53.7441.22.71.42.358726.102721.82.71.43.538081.61.91.11.738885.276960.82576

te1542.45.53.221.96482.75.52.922.393844.35862.46.13.224.360962.46.32.822.0147246.37568

vm1341.541.75.3042.23.62.18.6486413.952641.55.51.56.4351.8427.48813.923

ce1392.36.42.619.901442.35.71.912.9526832.854122.35.52.516.44525.52.514.330.745

Sheet2

numesexvarstaldZLdzgdZVdzlsZLsZgsZVsZVZldVLdVgdVVdVlsVLsVgsVVsVVVldMLdMgdMVdMlsMLsMgsMVsMVM

cf163252.613.522.242.310.524824.04482.43.31.77.001282.94.5213.57220.57328

se1281.63.70.82.462721.72.612.29844.761120.9311.4041412.083.484

am1214.46.7345.98882.15.92.214.1741660.162963.47337.1282.662.318.657655.7856

im1251.83.91.65.840641.63.11.64.126729.967361.73.51.54.6411.52.11.21.96566.6066

fm1611.83.326.17761.53.61.85.054411.2322.44.7211.73121.93.11.64.9004816.63168

am1640.9512.34352.317.9420.2824.21.14.80483.35.32.522.73727.5418

gf1301.63.61.75.091841.83.71.24.155849.2476823.21.54.9921.92.512.477.4621.78568

cg1171.23.21.12.196481.23.51.53.2765.472482.14.31.67.512961.63.112.579210.09216

ga1282.34.61.68.802562.13.91.56.388215.190762.841.37.57122.13.71.45.6565613.22776

pn1551.94.62.29.9985624.92.412.230422.228961.84.32.18.452082.34.22.613.0603221.51240.71656

pi1351.641.65.324825.21.89.734415.05921.83.31.44.324321.42.912.11126.43552

rc2132.65.72.821.577922.55.3320.6742.247923.25.62.220.500482.35.11.710.3693230.8698

ul2311.24.51.54.212141.53.127.3321.63.51.44.07681.34.71.13.494927.57172

bi2514.77.25.393.263044.97.24.582.5552175.8182466.64.286.48644.77.34.274.93304161.41944

dc1452.36.32.821.097442.46.52.822.713643.811042.45.72.819.918082.84.72.718.4766438.39472

ri1611.631.53.7441.22.71.42.358726.102721.82.71.43.538081.61.91.11.738885.27696

te1542.45.53.221.96482.75.52.922.393844.35862.46.13.224.360962.46.32.822.0147246.37568

vm1341.541.75.3042.23.62.18.6486413.952641.55.51.56.4351.8427.48813.923

ce1392.36.42.619.901442.35.71.912.9526832.854122.35.52.516.44525.52.514.330.745

Sheet4

ldLdgdvdlsLdgdvdvv1v2dif%

p11.83.21.44.193281.42.912.11126.304486.37.91.620

1.74.41.55.834412.71.52.1067.940438.3936.9-1.493.9

p22.45.72.819.918082.84.72.718.4766438.394726.033.39-2.6426

2.45.22.516.22435.12.620.685636.90966.035.490.540.0895522388

p313.511.821.831.54.2126.03225.320.135.170.2043478261

1.5413.121.53.51.23.2766.39643.939.74.20.0956719818

p31.631.53.74425210.414.14455.8949.95.990.1071748077

1.52.812.1841.85.31.57.44129.625265.9864.191.790.0271294332

p42428.321.561.88.42416.7447.156.750.40.0559440559

1.83.827.11361.56.5210.1417.253614.149.624.520.3196605375

p5131.21.87222.31.53.5885.4617.2516.740.510.0295652174

1.32.81.52.839222.51.53.96.73926.745.461.280.1899109792

17.4510.926.530.3742120344

5.454.540.910.1669724771

67.359.987.320.1087667162

18.9816.92.080.1095890411

13.2312.011.220.0922146636

27.523.93.60.1309090909

18.9516.232.720.1435356201

9.58.31.20.1263157895

32.928.754.150.1261398176

23.521.432.070.0880851064

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45.744.90.80.0175054705

34.934.860.040.0011461318

Sheet3

EZCVVMz-cz-mc-m

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6.7564.761123.4841.994883.2721.27712

59.54660.1629655.7856-0.616963.76044.37736V1-V2V1-V3V2-V3

9.967366.60667.673.360762.29736-1.0634media3.713.832.3

11.23216.6316814.32-5.39968-3.0882.31168max13.4914.49.01

20.2827.541818.53-7.26181.759.0118min0.010.030.14

9.247687.4626.5381.785682.709680.924ds3.953.452.27

5.4724810.092166.86-4.61968-1.387523.23216mediana2.912.011.4

15.1907613.2277614.751.9630.44076-1.52224

22.2289621.512420.8970.716561.331960.6154

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175.81824161.41944165.9714.39889.84824-4.55056min0.010.030.14min0.04

43.8110438.3947239.425.416324.39104-1.02528ds3.953.452.27ds2.2

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44.358646.3756840.253-2.017084.10566.12268

13.9526413.92313.650.029640.302640.273

32.8541230.74530.122.109122.734120.625

62.4560.7557.321.75.133.43

deficit iodateutiroidiehipertiroidiehipotiroidie

00000

2208120.66

43818261.33

6562740.52

97337.561.53

128044.5704

248057588

4880602016

Sheet3

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000

000

000

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000

000

000

000

000

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EZ

CV

VM

0000

0000

0000

p > 0,05

p > 0,05

p > 0,05

media

max

min

mediana

0000

media

max

min

mediana

0000

0000

0000

0000

0000

0000

0000

0000

2

4

6

12

24

48

deficit iodat

eutiroidie

hipertiroidie

hipotiroidie

timp (ore)

captarea I-131 (%)

Eutiroidie

Hipertiroidie

Hipotiroidie

Deficit iodat

Patologia tiroidian nodularNodul caldNodul rece

Tiroidita de QuervainPatologia tiroidian difuzAbsenta captarii

Tiroidita autoimunT. atroficPatologia tiroidian difuzT. Hashimoto

Boala Graves-Basedow

Noduli tiroidieniFNAB asistata echografic