43 research outputs found
Tireotropin i hormoni Å”titnjaÄe u eutireoidnom Hashimotovu tireoiditisu
Little is known about thyrotropin (TSH) and thyroid hormones in euthyroid Hashimotoās thyroiditis (HT), thus the aim was to investigate TSH and thyroid hormone economy in euthyroid HT and its relation to thyroid function. Ninety-five patients with euthyroid HT with normal TSH and thyroid hormones on the last follow up between 2009 and 2011 were investigated. Previous observation period ranged from 1.5 to 4.8 (mean 2.8) years, and they had never been treated with levothyroxine. The results of TSH and thyroid hormones were compared with 210 healthy subjects and expressed as median (25%-75%). According to TSH value, the subjects were divided into quartiles: TSH 0.4-0.99 (1q), 1.0-1.99 (2q), 2.0-2.99 (3q) and 3.0-4.0 mIU /L (4q). Euthyroid HT patients had higher TSH (2.53 [1.79-3.14] vs.1.95 [1.24-2.72], p<0.001). T4 and T3 were not different. The distribution of TSH in HT patients was significantly shifted to the right; 71% of patients were in the 3q and 4q groups. When HT patients with higher TSH (3q and 4q) were compared with those with lower TSH (1q and 2q), significant differences emerged in TSH (3.01 [2.48-3.48] vs.1.45 [1.07-1.71] mIU /L), T4 (99.0 [88.2-112.0] vs.112.0 [105.0-122.0] nmol/L) and T3 (1.78 [1.48-2.05] vs. 2.10 [1.85-2.21] nmol/L; p<0.01). TPO values were similar in both groups. A gradually increasing proportion of euthyroid HT patients with at least one supranormal TSH during the observation period were found: 0% in 1q, 10% in 2q, 15% in 3q and 44% in 4q TSH group. Euthyroid HT patients maintain euthyroidism only under strenuous TSH stimulation. The patients with high normal TSH are identified as those with a major risk of hypothyroidism in the near future.Malo je poznato o vrijednostima tireoptropina (TSH) i hormona Å”titnjaÄe u eutireoidnom Hashimotovu tireoiditisu (HT) te je cilj bio istražiti razinu TSH i hormona Å”titnjaÄe u HT i njihov odnos prema funkciji Å”titnjaÄe. Ispitano je 95 bolesnika s eutireoidnim HT s normalnim TSH i hormonima Å”titnjaÄe na posljednjoj kontroli izmeÄu 2009. i 2011. godine. Prethodno razdoblje promatranja variralo je od 1,5 do 4,8 (u prosjeku 2,8) godina, bolesnici nisu nikada lijeÄeni levotiroksinom. Rezultati TSH i hormona Å”titnjaÄe usporeÄeni su s onima u 210 zdravih osoba i prikazani kao medijan (25%-75%). Prema vrijednosti TSH ispitanici su podijeljeni u kvartile: TSH 0,4-0,99 (1q), 1,0-1,99 (2q), 2,0-2,99 (3q) i 3,0-4,0 mIU /L (4q). Eutireoidni bolesnici s HT imali su viÅ”i TSH (2,53 [1,79-3,14] prema 1,95 [1,24-2,72], p<0,001). T4 i T3 se nisu razlikovali. Raspodjela TSH u HT izrazito je pomaknuta udesno. Ukupno je 71% bolesnika bilo u skupini 3q i 4q. Kada se usporede HT bolesnici s viÅ”im (3q i 4q) i nižim TSH (1q i 2q) nalaze se znaÄajne razlike u TSH (3,01 [2,48-3,48] prema 1,45 [1,07-1,71] mIU /L), T4 (99,0 [88,2-112,0] prema 112,0 [105,0-122,0] nmol/L) i T3 (1,78 [1,48- 2,05] prema 2,10 [1,85-2,21] nmol/L; p<0,01). Vrijednosti TPO bile su sliÄne u obje skupine HT bolesnika. Opažen je postupni porast postotka eutireoidnih HT bolesnika s najmanje jednom poviÅ”enom vrijednoÅ”Äu TSH tijekom razdoblja promatranja: 0% u skupini 1q, 10% u 2q, 15% in 3q i 44% u skupini 4q. Eutireoidni bolesnici s HT održavaju eutireozu jedino uz poveÄanu stimulaciju pomoÄu TSH. Bolesnici s visoko normalnim TSH imaju najveÄi rizik nastupa hipotireoze u bliskoj buduÄnosti
Tumor mozga kao prototip teÅ”kog moždanog oÅ”teÄenja u bolesnika sa āsindromom niskog t3ā
The purpose of our study was to contribute to better understanding of cerebrospinal fluid (CSF) as a valuable biological material in the research of brain tumors within the ālow T3 syndromeā, and to discuss the role of thyroid hormones in the central nervous system in subjects
with severe cerebral lesions. We studied the levels of total triiodothyronine (tT3), total thyroxine (tT4), free triiodothyronine (fT3), free thyroxine (fT4), reverse triiodothyronine (rT3) and thyrotropin
(TSH) in serum, and fT3, fT4, rT3 and TSH levels in CSF of patients with brain tumor, and compared the results with control group. Study results indicated a statistically significantly higher level of rT3 in serum and CSF of brain tumor patients vs. control group (p<0.05). The rT3/fT3 ratio was highest in CSF and serum of brain tumor patients, yielding a statistically significant difference (p<0.05). These results could suggest higher permeability of the blood brain barrier in brain tumor patients. We also assume that rT3, in the framework of ācerebral low T3 syndromeā, is also generated through local intracerebral conversion. Disruption of this process in severe cerebral lesion can lead
to increased rT3 concentrations, i.e. development of the ālow T3 syndromeā.Cilj studije bio je doprinijeti boljem poznavanju cerebrospinalne tekuÄine kao vrijednog bioloÅ”kog materijala u istraživanju moždanih tumora i āsindroma niskog T3ā, te razmotriti ulogu hormona Å”titnjaÄe unutar srediÅ”njega živÄanog sustava kod bolesnika s ozbiljnim moždanim oÅ”teÄenjem. Analizirali smo razinu ukupnog trijodtironina (tT3), ukupnog tiroksina (tT4), slobodnog trijodtironina (fT3), slobodnog tiroksina (fT4), reverznog trijodtironina (rT3) i tireotropina (TSH) u serumu i razinu fT3, fT4, rT3 i TSH u cerebrospinalnoj tekuÄini u bolesnika s tumorom mozga te dobivene rezultate usporedili s kontrolnom skupinom ispitanika. Rezultati su ukazali na statistiÄki znaÄajno veÄu razinu rT3 u serumu i cerebrospinalnoj tekuÄini u bolesnika s tumorom mozga u usporedbi s kontrolnom skupinom (p<0,05). Odnos rT3/fT3 bio je takoÄer statistiÄki znaÄajno veÄi kod bolesnika s tumorom mozga (p<0,05). NaÅ”e istraživanje moglo bi ukazivati na veÄu propustljivost krvno-moždane barijere u bolesnika s tumorom mozga. TakoÄer pretpostavljamo da se u bolesnika s tumorom mozga rT3 pojaÄano stvara kroz aktivniju intracerebralnu pretvorbu. Svakako, naÅ”i rezultati trebaju biti potvrÄeni i daljnjim podrobnijim istraživanjima
Incidentno poviÅ”ena vrijednost tireotropina u inaÄe dobro lijeÄenih hipotireoidnih bolesnika ne zahtijeva poviÅ”enje doze levotiroksina
In 20 properly treated hypothyroid patients with normal thyrotropin (TSH) values during previous observation, TSH was incidentally mildly/moderately elevated (4.5-8.0 mIU/L; normal values 0.4-4.0) on the last follow up. However, they were continuously treated with the same levothyroxine (LT 4) dose (mean: 95 Ī¼g) and six months later all TSH values normalized. The authors suggest that the physicians, in response to incidentally increased TSH value in otherwise properly treated hypothyroid patients, refrain from prompt increasing the LT 4 dose unless TSH values are persistently elevated or/and progressing.Kod 20 hipotireoidnih bolesnika koji su prethodno dobro lijeÄeni uz uredne vrijednosti tireotropina (TSH) na posljednjoj kontroli naÄena je blago do umjereno poviÅ”ena vrijednost TSH (4,5-8,0 mIU/L: n.v. 0,4-4,0). Ipak je nastavljeno lijeÄenje istom dozom levotiroksina (LT 4), u prosjeku 95 Ī¼g, a nakon 6 mjeseci vrijednosti TSH su se normalizirale. Autori preporuÄuju da se lijeÄnik suoÄen s incidentno poviÅ”enom vrijednoÅ”Äu TSH u inaÄe dobro lijeÄenih hipotireoidnih bolesnika suzdrži od poviÅ”enja doze LT 4 ako vrijednost TSH nije trajno poviÅ”ena i/ili u progresiji
Internal jugular vein thrombosis caused by invasive pharyngeal cancer: a case report and literature review
INTRODUCTION: Internal jugular vein (IJV) thrombosis is a potentially life-threating disease and can occur
at any level. Variety of factors can induce thrombosis, but it is most often found following IJV catheterization,
neck dissection, injuries, infectious disease, in ovarian hyperstimulation syndrome or in malignant neoplasms.
Unlike thyroid cancer, in which thrombosis of the jugular vein have been relatively often described, thrombosis
of the internal jugular vein in head and neck squamous cell cancer is extremely rare. OBJECTIVE: We report
a unique case of a very advanced, locally invasive pharyngeal tumor causing thrombosis of the internal jugular
vein. Literature review of the described topic was also conducted. MATERIAL AND METHODS: A crossreferenced PubMed and Scopus (EMBASE) search was performed and relevant data were extracted
accordingly. The search was performed using the following key-words and Boolean operators: āhead and neck
cancer AND squamous cell cancer AND internal jugular vein thrombosisā. RESULTS: According to PubMed
and Scopus search only two similar cases were found. The first patient had supraglottic SCC with N3 lymph
node invading IJV. The second patient developed SCC of the thyroid gland with a large IJV thrombosis. Both
patients were treated bimodally, but developed recurrences and died soon after the treatment. In our case,
patient was treated with radical surgery. Radical dissection of the right side of the neck and selective dissection
of the left side of neck levels II-IV were performed. Furthermore, total laryngectomy, subtotal pharyngectomy
and total thyroidectomy en bloc were performed. Reconstruction was made with a free fasciocutaneous
anterolateral thigh flap. Despite the patient\u27s poor general condition, IJV thrombosis, bulbus and sigmoid sinus
thrombosis, and several comorbidities, he was considered for curative therapy and is still alive, in good general
shape, 7 months after the surgery. DISCUSSION: The choice of treatment for this kind of patients is not
standardized due to its rare occurrence. Even though IJV thrombosis carries a high chance of distant metastasis
and local recurrence and consequently causing poor survival, the question arises what the best therapeutic
option is. More documented cases are undoubtedly required to draw a more solid conclusio
Internal jugular vein thrombosis caused by invasive pharyngeal cancer: a case report and literature review
INTRODUCTION: Internal jugular vein (IJV) thrombosis is a potentially life-threating disease and can occur
at any level. Variety of factors can induce thrombosis, but it is most often found following IJV catheterization,
neck dissection, injuries, infectious disease, in ovarian hyperstimulation syndrome or in malignant neoplasms.
Unlike thyroid cancer, in which thrombosis of the jugular vein have been relatively often described, thrombosis
of the internal jugular vein in head and neck squamous cell cancer is extremely rare. OBJECTIVE: We report
a unique case of a very advanced, locally invasive pharyngeal tumor causing thrombosis of the internal jugular
vein. Literature review of the described topic was also conducted. MATERIAL AND METHODS: A crossreferenced PubMed and Scopus (EMBASE) search was performed and relevant data were extracted
accordingly. The search was performed using the following key-words and Boolean operators: āhead and neck
cancer AND squamous cell cancer AND internal jugular vein thrombosisā. RESULTS: According to PubMed
and Scopus search only two similar cases were found. The first patient had supraglottic SCC with N3 lymph
node invading IJV. The second patient developed SCC of the thyroid gland with a large IJV thrombosis. Both
patients were treated bimodally, but developed recurrences and died soon after the treatment. In our case,
patient was treated with radical surgery. Radical dissection of the right side of the neck and selective dissection
of the left side of neck levels II-IV were performed. Furthermore, total laryngectomy, subtotal pharyngectomy
and total thyroidectomy en bloc were performed. Reconstruction was made with a free fasciocutaneous
anterolateral thigh flap. Despite the patient\u27s poor general condition, IJV thrombosis, bulbus and sigmoid sinus
thrombosis, and several comorbidities, he was considered for curative therapy and is still alive, in good general
shape, 7 months after the surgery. DISCUSSION: The choice of treatment for this kind of patients is not
standardized due to its rare occurrence. Even though IJV thrombosis carries a high chance of distant metastasis
and local recurrence and consequently causing poor survival, the question arises what the best therapeutic
option is. More documented cases are undoubtedly required to draw a more solid conclusio
ZaÅ”to bolesnica s Gravesovom boleÅ”Äu ostaje eutiroidna/blago hipertiroidna nakon totalne tiroidektomije - uloga antitijela na tirotropinske receptore (TRAb) i vestigalnih ostataka tiroglosalnog trakta
A young female patient suffering from Graves. disease is presented, who raised some diagnostic and therapeutic dilemmas after being diagnosed with subclinical hyperthyroidism following total thyroidectomy. This 20-year-old female patient, carrier of HLA B8 DR3 genes, was referred to our hospital for total thyroidectomy after developing severe leukopenia on both methimazole and propylthiouracil therapy. A high postoperative titer of thyrotropin receptor antibodies and positive scintigraphy finding of the pyramidal lobe and remnant thyroid tissue in the left thyroid lobe led to the administration of radioiodine. Despite further enlargement of the remnant thyroid tissue on post-radioiodine scintiscanning, the patient is currently euthyroid, with normal thyroid-stimulating hormone levels; however, her long-term prognosis remains uncertain.Opisan je sluÄaj bolesnice operirane zbog hipertireoze na podlozi Gravesove bolesti, u koje se na poÄetno primijenjenu medikamentnu terapiju razvila granulocitopenija. Iako je kod bolesnice bila planirana totalna tireoidektomija, s obzirom na prijeoperacijski neprepoznat lobus piramidalis uÄinjena je tek djelomiÄna resekcija Å”titnjaÄe. Poslijeoperacijski se kao posljedica autoimune aktivacije ostatnog tkiva Å”titnjaÄe antitijelima na tirotropinske receptore (TRAb) razvila hipertireoza, pa je daljnji tijek bolesti joÅ” uvijek nesiguran
Ameloblastom donje Äeljusti u bolesnice s Turnerovim sindromom - prikaz sluÄaja
Ameloblastom je benigni tumor koji nastaje iz odontogenih epitelnih stanica. Pokazuje lokalno agresivni naÄin
rasta, uz razaranje koÅ”tanoga tkiva gornje ili donje Äeljusti. Javlja se u svim dobnim skupinama. Ameloblastom
najÄeÅ”Äe zahvaÄa donju (80%), a rjeÄe gornju Äeljust. KliniÄki se oÄituje kao bezbolna oteklina koja ima
sklonost rasta, s posljediÄnom pojavom deformacije lica i Äeljusti, malokluzije, trizmusa, te boli. U literaturi
je opisana povezanost ameloblastoma s nizom sindroma poput Gorlinovog, sindromom epidermalnog nevusa,
Simpson-Golabi-Behmelovog te Williamsovog sindroma, no njegova veza s Turnerovim sindromom nije
opisana. Prikazujemo sluÄaj bolesnice s ameloblastomom donje Äeljusti. Bolesnica s Turnerovim sindromom
javila se u ORL ambulantu radi otekline u podruÄju desne parotidomaseteriÄne regije. Kod bolesnice je
uÄinjena radioloÅ”ka obrada koja je ukazala na cistiÄni oseodestruktivni proces lokaliziran u trupu, te ramusu
desne strane donje Äeljusti. Tijekom operativnog zahvata nailazi se na razorenu desnu polovicu tijela, razoren
uzlazni krak i kondilarni nastavak donje Äeljusti. UÄinjena je segmentalna mandibulektomija transcervikalnim
pristupom s posljediÄnim defektom tipa IIc po Brownu. Kod bolesnice je bila planirana rekonstrukcija donje
Äeljusti slobodnim osealnim režnjem lisne kosti, od koje se odustalo radi nepodobne vaskularne anatomije obje
potkoljenice. Isti aberantni anatomski uzorak opisan je MSCT angiografijom i na obje duboke kružne ilijaÄne
arterije, onemoguÄujuÄi primjenjivost slobodnog režnja crijevne kosti. PatohistoloÅ”ka analiza potvrdila je da
se radi o ameloblastomu, folikularnom tipu. LijeÄenje ameloblastoma je prvenstveno kirurÅ”ko. Opseg kirurÅ”ke
resekcije ovisi o stupnju i mjestu zahvaÄenosti Äeljusti procesom. Konzervativnije metode kirurÅ”kog lijeÄenja,
poput kiretaže ili enukleacije, nisu preporuÄljive radi visokog rizika od recidiva (60-80%). Operativnom
zahvatu potrebno je pristupiti Å”to ranije zbog manjeg opsega zahvaÄenosti Äeljusti i posljediÄno manjeg opsega
resekcije. Postoperativno je potrebno kliniÄki, te radioloÅ”ki pratiti bolesnika minimalno 10 godina radi visokih
stopa recidiva bolesti. Iako postoji dokazana povezanost ameloblastoma s nizom sindroma, ista nije dokazana
u Turnerovu sindromu
Ameloblastom donje Äeljusti u bolesnice s Turnerovim sindromom - prikaz sluÄaja
Ameloblastom je benigni tumor koji nastaje iz odontogenih epitelnih stanica. Pokazuje lokalno agresivni naÄin
rasta, uz razaranje koÅ”tanoga tkiva gornje ili donje Äeljusti. Javlja se u svim dobnim skupinama. Ameloblastom
najÄeÅ”Äe zahvaÄa donju (80%), a rjeÄe gornju Äeljust. KliniÄki se oÄituje kao bezbolna oteklina koja ima
sklonost rasta, s posljediÄnom pojavom deformacije lica i Äeljusti, malokluzije, trizmusa, te boli. U literaturi
je opisana povezanost ameloblastoma s nizom sindroma poput Gorlinovog, sindromom epidermalnog nevusa,
Simpson-Golabi-Behmelovog te Williamsovog sindroma, no njegova veza s Turnerovim sindromom nije
opisana. Prikazujemo sluÄaj bolesnice s ameloblastomom donje Äeljusti. Bolesnica s Turnerovim sindromom
javila se u ORL ambulantu radi otekline u podruÄju desne parotidomaseteriÄne regije. Kod bolesnice je
uÄinjena radioloÅ”ka obrada koja je ukazala na cistiÄni oseodestruktivni proces lokaliziran u trupu, te ramusu
desne strane donje Äeljusti. Tijekom operativnog zahvata nailazi se na razorenu desnu polovicu tijela, razoren
uzlazni krak i kondilarni nastavak donje Äeljusti. UÄinjena je segmentalna mandibulektomija transcervikalnim
pristupom s posljediÄnim defektom tipa IIc po Brownu. Kod bolesnice je bila planirana rekonstrukcija donje
Äeljusti slobodnim osealnim režnjem lisne kosti, od koje se odustalo radi nepodobne vaskularne anatomije obje
potkoljenice. Isti aberantni anatomski uzorak opisan je MSCT angiografijom i na obje duboke kružne ilijaÄne
arterije, onemoguÄujuÄi primjenjivost slobodnog režnja crijevne kosti. PatohistoloÅ”ka analiza potvrdila je da
se radi o ameloblastomu, folikularnom tipu. LijeÄenje ameloblastoma je prvenstveno kirurÅ”ko. Opseg kirurÅ”ke
resekcije ovisi o stupnju i mjestu zahvaÄenosti Äeljusti procesom. Konzervativnije metode kirurÅ”kog lijeÄenja,
poput kiretaže ili enukleacije, nisu preporuÄljive radi visokog rizika od recidiva (60-80%). Operativnom
zahvatu potrebno je pristupiti Å”to ranije zbog manjeg opsega zahvaÄenosti Äeljusti i posljediÄno manjeg opsega
resekcije. Postoperativno je potrebno kliniÄki, te radioloÅ”ki pratiti bolesnika minimalno 10 godina radi visokih
stopa recidiva bolesti. Iako postoji dokazana povezanost ameloblastoma s nizom sindroma, ista nije dokazana
u Turnerovu sindromu