[01] Stres kai qyreoeidopaqeies

``Polloi aitiologikoi paragontes, ejwgeneis kai endogeneis, exoyn enoxopoihqei gia thn kataigida ths emfanishs qyreoeidikhs aytoanosias, opws to idio to iwdio se megales doseis, diaforoi periballontikoi paragontes, farmaka, h klhronomikh prodiaqesh k.a. Wstoso, kentriko rolo sthn emfanish aytwn twn noshmatwn se klhronomika prodiateqeimena, kai mh, atoma, katexei to epimono stres, ayto dhladh to opoio den mporei na to diaxeirisqei h na to eklogikeysei to atomo kai kyriws to legomeno cyxokoinwniko stres'', epishmane o endokrinologos-epimelhths endokrinologikhs klinikhs toy Nosokomeioy ``Panagia'', Nikolaos Pontikidhs, kata th diarkeia synenteyjhs Typoy me aformh thn 25 Maioy, Paneyrwpaikh Hmera Qyreoeidoys.

Opws exoyn katadeijei polles ereynes, opws ayth ths episthmonikhs omadas toy Ellhna kaqhghth Xroysoy, sto Eqniko Institoyto Ygeias twn HPA, sth diarkeia toy stres kai sthn prospaqeia, poy kataballei o organismos gia na antimetwpisei ton eperxomeno kindyno, ayjanontai dyo shmantikes ormones twn epinefridiwn, h kortizolh kai oi katexolamines (adrenalinh, noradrenalinh). Oi ormones aytes exoyn ws apotelesma na diatarassetai h kyttarikh kai xymikh anosia, mesw enos polyplokoy katarrakth antidrasewn. Analoga me tis peristaseis, eite yperterei h prwth kai katastrefontai kyttara, eite yperterei h xymikh anosia kai diegeirontai ta kyttara, opws sthn periptwsh p.x. toy yperqyreoeidismoy.

``Etsi ejhgeitai to gegonos oti polloi anqrwpoi biwnoyn aifnidia emfanish yperqyreoeidismoy kai ypoqyreoeidismoy h kai allwn noshmatwn, epeita apo entona stresogona gegonota ths zwhs toys opws xwrismos, qanatos, oikonomikh stenothta k.lp. Malista, yparxoyn dhmosieyseis ayjhshs twn posostwn toy yperqyreoeidismoy kai se periodoys polemoy, opws p.x. sth Serbia metajy 1992-1995, opoy diapistwqhke megalh kai apotomh ayjhsh newn epeisodiwn'', prosqese o k. Pontikidhs.

H qyreoeidikh ofqalmopaqeia

H qyreoeidikh ofqalmopaqeia, mia aytoanosh diataraxh ths opoias o akribhs paqogenetikos mhxanismos den exei plhrws dieykrinisqei, apotelei th syxnoterh ejwqyreoeidikh ekdhlwsh ths nosoy toy Graves, poy, sth sobaroterh morfh ths, epideinwnei thn poiothta zwhs twn asqenwn. Xarakthrizetai apo ayjhsh toy ogkoy twn ejofqalmiwn mywn, kaqws kai toy opisqobolbikoy lipwdoys kai syndetikoy istoy.

Pososto peripoy 5% apo toys asqeneis me noso toy Graves pasxoyn apo poly sobarh qyreoeidikh ofqalmopaqeia. Oi andres fainetai oti emfanizoyn sobarotera problhmata se sxesh me tis gynaikes. Endiaferon exei oti h qyreoeidikh ofqalmopaqeia mporei na emfanizetai prin, taytoxrona, h meta, apo thn emfanish ths kyrias nosoy (nosos toy Graves). Stis hpies morfes, afoy kanei ton kyklo ths, se ena megalo pososto beltiwnetai aytomata, enw pososto peripoy 5% me sobarh noso xreiazetai qerapeytikh antimetwpish gia na apofeyxqoyn h optikh neyritida kai h tyflwsh'', epishmane o dieyqynths endokrinologikhs klinikhs toy Nosokomeioy ``Panagia'', Gerasimos Krassas.

Yparxoyn treis basikoi tropoi antimetwpishs ths nosoy. Farmakeytikh, aktinobolhsh twn kogxwn kai xeiroyrgikh. To basiko farmako gia thn antimetwpish ths sobarhs ofqalmopaqeias einai h kortizonh, h opoia shmera xorhgeitai endoflebiws. H farmakeytikh qerapeia exei eynoika apotelesmata se pososto 60-65% twn arrwstwn. Teleytaia, dokimazontai nea farmaka, opws h ritoyjimpamh kai pentojyfilinh. H pentojyfilinh dokimasqhke se mia megalh paneyrwpaikh polykentrikh meleth, ta apotelesmata ths opoias qa dhmosieyqoyn poly syntoma.

O karkinos toy qyreoeidoys

O karkinos toy qyreoeidoys einai o pio syxnos karkinos twn endokrinwn adenwn, prosballei oles tis hlikies kai kyriws tis gynaikes. Synhqws anaptyssetai se proyparxontes ozoys toy qyreoeidh, poy einai syxnoi ston ygih plhqysmo, einai kata kanona asymptwmatikos kai exei kalh prognwsh.

Ta mikrokarkinwmata kai diametroy mikroterhs toy enos ekatostoy kai ta perissotera, den ejelissontai se kliniko karkino. Peribantologikoi kai genetikoi paragontes pisteyetai oti symmetexoyn ston kindyno gia emfanish karkinoy toy qyreoeidh.

``H monh safhs aitiologia fainetai oti einai h ekqesh se ejwterikh aktinobolia, kata th diarkeia ths paidikhs kai efhbikhs hlikias. H epidrash kai allwn paragontwn, ektos ths aktinobolias, einai piqana aparaithth gia na ginei o karkinos klinika emfanhs. Me dedomenh thn 3plasia epiptwsh toy karkinoy stis gynaikes, diafores epidhmiologikes meletes exoyn elegjei thn piqanh sysxetish toy me paragontes anaparagwghs kai ormones. Ayjhmenos deikths mazas swmatos stis gynaikes syndeetai amesa me emfanish karkinoy toy qyreoeidh'', anefere h endokrinologos, dieyqyntria endokrinologikhs klinikhs toy Qeageneioy Nosokomeioy, Kallioph Pazaitoy.

Tis teleytaies dekaeties h syxnothta toy ayjhqhke stis biomhxanopoihmenes xwres. Stis perissoteres periptwseis, h ayjhsh afora to qhlwdes karkinwma kai kyriws ogkoys mikroteroys apo ena ekatosto, enw oi ypoloipoi istologikoi typoi den emfanisan shmantikh ayjhsh. H ayjhsh den synodeyetai kai apo ayjhsh twn qanatwn.

``Ta teleytaia dyo xronia jekinhsame mia filodojh prospaqeia katagrafhs toy en logw karkinoy sthn endokrinologikh klinikh toy Qeageneioy Nosokomeioy Qessalonikhs, poy apotelei kentro anaforas ths nosoy gia th Boreio Ellada. Apo mia prwth ektimhsh twn apotelesmatwn fainetai oti o karkinos toy qyreoeidh exei yperdiplasiasqei thn teleytaia dekaetia. Einai poly piqano h ayjhsh ayth na diapistwnetai, epeidh yparxoyn akribesteres meqodoi diagnwshs, opws to yperhxografhma kai h biocia me lepth belonh'', ejhghse h k. Pazaitoy.

Na shmeiwqei oti to yperhxografhma entopizei ozoys mikroys, ws 2 mm, den einai omws se qesh na entopisei me akribeia toys ozoys me karkino. Etsi, einai poly pio eyaisqhto apo ta daktyla toy ejetasth, poy chlafoyn ozoys diametroy megalyterhs toy enos ekatostoy. Ypologizetai oti 20% twn enhlikwn exoyn chlafhto ozo kai 67% ozo emfanh sto yperhxografhma. Asqeneis stoys opoioys diagignwsketai karkinos toy qyreoeidh me lepth belonh, oso mikros kai an einai, odhgoyntai se qyreoeidektomh, prokeimenoy na mhn yparjoyn epiplokes, opws ypoqyreoeidismos kai ejarthsh apo th qyrojinh ef'oroy zwhs, ypoparaqyreoeidismos me ejarthsh apo asbestio kai bitaminh D, blabh sto laryggiko neyro kai dyskolies sth fwnhsh.

H qerapeia toy diaforopoihmenoy karkinoy toy qyreoeidh einai xeiroyrgikh kai skopos einai na afaireqei kaqe karkinikh estia. Metegxeirhtika, ena megalo meros asqenwn, poy briskontai se kindyno gia ypotropes h metastaseis, ypoballetai se katastrofh toy qyreoeidikoy ypoleimmatos me th xorhghsh radienergoy iwdioy, enw oloi ypokeintai se qerapeia me qyrojinh ef' oroy zwhs.

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