Utente:OppidumNissenae/Sandbox01
Ipertiroidismo e trauma Il decorso clinico degli individui dopo il trauma in gran parte è determinata dal loro stato traumatico pre. Il sistema endocrino svolge un ruolo importante nella risposta al danno, la chirurgia, e sepsi e disfunzione endocrina pone la vittima trauma a rischio di maggiore morbilità e mortalità. Inoltre, malattie endocrine cronica di solito è accompagnato da una disfunzione multiorgano, che possono compromettere la riserva fisiologica del paziente gravemente ferito. Tra i pazienti con malattie endocrine preesistente, le gravi sollecitazioni di trauma multisistemica può portare a un ulteriore, spesso sottile, scompenso a funzione endocrina (Fig. 1).[1]
1 Cachessia[modifica | modifica wikitesto]
Questo articolo è una revisione delle attuali conoscenze delle risposte ormonali e metaboliche a traumi e chirurgia. I fattori che possono mediare le risposte sono discussi e il valore potenziale di diverse manipolazioni terapeutiche sono rivisti. La degradazione accelerata del muscolo dopo un trauma significativo è il tratto più caratteristico della risposta metabolica. L'entità della perdita muscolare potenzialmente proporzionale alla portata del pregiudizio, porta ad una marcata cachessia che potrebbe essere considerato parte della insufficienza organica multipla. Sembra che la perdita di proteine e la immunodepressione che spesso si verifica dopo un trauma grave possono essere fattori importanti nel determinare morbilità e mortalità dei pazienti. La prevenzione o l'attenuazione della risposta allo stress metabolico potrebbe essere utile nel migliorare immunocompetence e riducendo al minimo le complicanze dopo importanti traumi o interventi chirurgici in modo che un ritorno in precedenza per la salute normale potrebbe essere raggiunto. Al momento ci sono pochi dati epidemiologici per sostenere questo punto di vista, ma è un concetto interessante nella gestione di un paziente gravemente malati. Siamo consapevoli del fatto che le tecniche di anestesia, il supporto nutrizionale, normotermia e manipolazione ormonale possono modificare una parte della risposta ormonale e metabolico di chirurgia. La conoscenza di tutti loro e le implicazioni cliniche che il loro uso potrebbe avere, sarà utile ai anestesisti e medici di terapia intensiva nel loro lavoro giornaliero nella sala operatoria, unità di terapia intensiva o nel reparto di chirurgia. [2]
2 Casco e trauma tiroide[modifica | modifica wikitesto]
Direct trauma to the thyroid area (such as may be caused by the chin strap of a motorcycle helmet) has been documented as causinga traumatic thyroiditis, but is not known to cause an acute hyperthyroid state[3] (full Paper:[1] cit.:[4])
3 Gozzomultinodulare traumi collo[modifica | modifica wikitesto]
Endocr Pract. 2003 Jan-Feb;9(1):5-11. PMID: 12917086[5] Discovery of unsuspected thyroid pathologic conditions after trauma to the anterior neck area attributable to a motor vehicle accident: relationship to use of the shoulder harness. Dickey RA(1), Parker JL, Feld S. Author information: (1)Piedmont Pathology, Hickory, North Carolina, USA.
OBJECTIVE: To alert physicians to the possibility of antecedent trauma to the neck in patients presenting with a thyroid nodule or with symptoms and signs related to the thyroid gland. METHODS: We present five case reports in which the cause of thyroid nodular disease was suspected to have been trauma to the anterior neck area during an earlier motor vehicle accident in which the shoulder harness impacted the neck. RESULTS: In five female patients, shoulder harness trauma from an automobile accident led to the subsequent discovery of a thyroid lesion. Four of the five patients underwent surgical removal of the thyroid nodule. Although traumatic injury of the thyroid may be common, we found only one report in the medical literature regarding the discovery of a thyroid nodule or thyroiditis in the setting of traffic accident-related trauma to the thyroid gland. CONCLUSION: In the initial assessment of patients with thyroid nodular disease, we emphasize the importance of obtaining a detailed and comprehensive history,including inquiry about trauma to the neck. Prompt diagnostic accuracy will help avoid unnecessary costs and risks in the workup of such patients. TRADUZIONE: OBIETTIVO allertare i medici alla possibilità di traumi antecedente al collo in pazienti con un nodulo tiroideo o con sintomi e segni legati alla ghiandola tiroidea. METODI: Vi presentiamo cinque casi clinici in cui la causa della nodulare della tiroide malattia è stata sospettata di essere stato un trauma alla zona del collo anteriore durante un in precedenza incidente automobilistico in cui la bretella colpito al collo. RISULTATI: In cinque pazienti di sesso femminile, spalla imbragatura trauma da un'automobile incidente ha portato alla successiva scoperta di una lesione tiroidea. Quattro dei cinque pazienti sono stati sottoposti rimozione chirurgica del nodulo tiroideo. Anche se traumatico lesioni della tiroide può essere comune, abbiamo trovato solo un rapporto in campo medico letteratura per quanto riguarda la scoperta di un nodulo tiroideo o tiroidite nel regolazione del traffico incidenti legati trauma alla ghiandola tiroidea. In conclusione, nella valutazione iniziale dei pazienti con malattia nodulare della tiroide, sottolineiamo l'importanza di ottenere una storia dettagliata e completa, compresi inchiesta circa un trauma al collo. accuratezza diagnostica Prompt aiuterà evitare inutili costi e rischi nel iter di tali pazienti.
4 Tiroide rottura[modifica | modifica wikitesto]
Am J Emerg Med. 2013 Apr;31(4):760.e3-5. doi: 10.1016/j.ajem.2012.12.005. Epub 2013 Feb 8.[6] Thyroid rupture secondary to blunt neck trauma. Sow YL1, Aziz NA, Ng KL.
Abstract Rupture of the thyroid gland is uncommon in cases of blunt neck trauma. We report a case of thyroid rupture after a motor vehicle accident in a patient without a preexisting goiter. He presented with a painful anterior neck swelling associated with dysphagia and hoarseness of voice. Computed tomographic scans showed lacerations of the right thyroid lobe and isthmus with features suggestive of slow active bleeding. Neck exploration was subsequently performed, and a ruptured right thyroid lobe was found with ongoing venous hemorrhage. A right hemithyroidectomy was performed, and the patient recovered without complications.
TRADUZIONE: La rottura della ghiandola tiroidea è raro nei casi di trauma al collo smussato. Riportiamo un caso di rottura della tiroide dopo un incidente automobilistico in un paziente senza un gozzo preesistente. Ha presentato con un doloroso gonfiore del collo anteriore associata con la disfagia e raucedine di voce. Le scansioni TC hanno mostrato lacerazioni del lobo tiroideo destro e istmo con caratteristiche suggestive di sanguinamento attivo lento. l'esplorazione del collo è stato successivamente effettuato, e un lobo destro della tiroide rottura è stato trovato con emorragia venosa in corso. Un emitiroidectomia destra è stata eseguita, e il paziente ha recuperato senza complicazioni.
5 Tiroide rottura[modifica | modifica wikitesto]
Tiroide rottura seguente smussato trauma è estremamente raro, e dolore al collo, senza gonfiore può essere l'unico sintomo di presentazione. Tuttavia, emorragia ed ematoma successivamente provoca gravi compressione tracheale e distress respiratorio.[7]
6 Case report: Tiroide rottura[modifica | modifica wikitesto]
Isolato trauma alla tiroide è molto raro e ci sono pochi casi riportati in letteratura. ... A 19 anni, paziente senza patologie note che hanno subito smussato diretta trauma per la metà destra anteriore del collo dopo essere caduto giù da una scalinata. E 'arrivata al pronto soccorso con moderata gonfiore al collo e dolore. Non ci sono stati ematomi visibili e senza compromissione respiratoria è stato notato.[8]
7 ipertiroidismo subclinico e rischio fratture[modifica | modifica wikitesto]
Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.[9]
Note[modifica | modifica wikitesto]
- ^ Boulanger BR, Gann DS, Management of the trauma victim with pre-existing endocrine disease, in Crit Care Clin, vol. 10, n. 3, 1994, pp. 537–54, PMID 7922737.
- ^ Persani L, Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges, in J. Clin. Endocrinol. Metab., vol. 97, n. 9, 2012, pp. 3068–78, DOI:10.1210/jc.2012-1616, PMID 22851492.
- ^ Fitz-Henry J, Riley B, Thyrotoxicosis in a patient with multiple trauma: value of "AMPLE" history taking, in BMJ, vol. 313, n. 7063, 1996, pp. 997–8.
- ^ Leckie RG, Buckner AB, Bornemann M, Seat belt-related thyroiditis documented with thyroid Tc-99m pertechnetate scans, in Clin Nucl Med, vol. 17, n. 11, 1992, pp. 859–60, PMID 1330393.
- ^ Dickey RA, Parker JL, Feld S, Discovery of unsuspected thyroid pathologic conditions after trauma to the anterior neck area attributable to a motor vehicle accident: relationship to use of the shoulder harness, in Endocr Pract, vol. 9, n. 1, 2003, pp. 5–11, DOI:10.4158/EP.9.1.5, PMID 12917086.
- ^ Sow YL, Aziz NA, Ng KL, Thyroid rupture secondary to blunt neck trauma, in Am J Emerg Med, vol. 31, n. 4, 2013, pp. 760.e3–5, DOI:10.1016/j.ajem.2012.12.005, PMID 23399341.
- ^ Hara H, Hirose Y, Yamashita H, Thyroid gland rupture caused by blunt trauma to the neck, in BMC Res Notes, vol. 9, n. 1, 2016, p. 114, DOI:10.1186/s13104-016-1932-7, PMID 26892467.
- ^ Arana-Garza S, Juarez-Parra M, Monterrubio-Rodríguez J, Cedillo-Alemán E, Orozco-Agüet D, Zamudio-Vázquez Z, Garza-Jasso T, Thyroid gland rupture after blunt neck trauma: A case report and review of the literature, in Int J Surg Case Rep, vol. 12, 2015, pp. 44–7, DOI:10.1016/j.ijscr.2015.04.020, PMID 26001363.
- ^ Blum MR, Bauer DC, Collet TH, Fink HA, Cappola AR, da Costa BR, Wirth CD, Peeters RP, Åsvold BO, den Elzen WP, Luben RN, Imaizumi M, Bremner AP, Gogakos A, Eastell R, Kearney PM, Strotmeyer ES, Wallace ER, Hoff M, Ceresini G, Rivadeneira F, Uitterlinden AG, Stott DJ, Westendorp RG, Khaw KT, Langhammer A, Ferrucci L, Gussekloo J, Williams GR, Walsh JP, Jüni P, Aujesky D, Rodondi N, Subclinical thyroid dysfunction and fracture risk: a meta-analysis, in JAMA, vol. 313, n. 20, 2015, pp. 2055–65, DOI:10.1001/jama.2015.5161, PMID 26010634.
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(trauma OR traumatic) AND Thyroid[modifica | modifica wikitesto]
N. 733