يعتبر تضخم الدرقيه مرض شائع الحدوث خصوصا في المناطق التي تنعدم بها كمية اليود ويحدث التضخم نتيجة التحفيز المستمر من الغده النخاميه وذلك فافراز هرمون يسمى TSH.
وتقع الغده الدرقيه في الجزء الامامي الاوسط للرقبه تحت ما يعرف بتفاحة ادم محيطه بالحنجره من الامام وتتكون من فصين مرتبطان بعنق صغير وتشبه اجنحة الفراشه الممتده.
وتنتج الدرقيه هرمون الثيروكسين والذي يتحكم في نمو ونشاط الدماغ والجسم.
وعندما تتضخم الدرقيه فانه يصبح بالامكان ملاحظة ذلك بسهولة بمجرد النظر للرقبة الشخص المصاب.
بماذا يشعر المصاب ؟
قد يشعر المصاب ببعض الاعراض وقد لايظهرعليه شي منها ومن الاعراض تضخم في حجم الرقبه, قلق وتوتر, صعوبة في البلع , صعوبة التنفس, ألم في الرقبة,
بالاضافه لأعراض زيادة الافراز مثل العرق والنشاط الزائد ونقص الوزن او اعراض نقص الافراز مثل الشعور بالبرد , الخمول, زيادة الوزن, الامساك , تغير في الصوت, جفاف الجلد وتساقط الشعر.
الاسباب:
1- ضعف الدرقية: قد يكون بسبب وجود أجسام مضادة (مرض هاشيموتو) , التهابات الدرقية او نقص احد إنزيمات الدرقية.
2- زيادة نشاط الدرقية: مرض قريفز Graves ويحصل بسبب وجود اجسام مضادة محفزه للدرقيه وتؤدي لزيادة حجمها , ويكون هرمون النخامية المحفز للدرقية TSH عند ادنى مستوياته.
3- نقص اليود: واليود يعتبر العنصر الاساسي في انتاج الثيروكسين وبدونه لاتعمل الدرقية وقد كان هذا المرض شائع الانتشار في الماضي ولكن بعد اضافة اليود على الطعام فقد قل انتشار المرض .
4- الأورام: سواء كانت حميده أو غير حميده أو اكياس حوصليه فقد تؤدي الى تضخم جزئي في الدرقية وغالبا مايكون في جانب واحد من الدرقيه وينمو بصوره مستمره.
5- عقد حوصليه عديده : Multinodular goiter وتكون هناك مجموعة عقد حوصلية منتشرة في الدرقية تؤدي للتضخم وقد يصاحبها زيادة في نشاط الدرقية.
الفحوصات اللازمة:
تحليل وظيفة الدرقية TSH-T3-T4
اشعة صوتيه للدرقية
قياس الاجسام المضادة للدرقية
من النادر نحتاج لعمل اشعة نوويه للدرقية
عمل خزعة عينة عند وجود تضخم في جانب واحد واشتباه وجود ورم.
العلاجات
- اذا كان هناك زيادة في نشاط الدرقيه فيعالج بالادويه مثل نيومركازول أو باليود المشع
- اذا كان هناك ضعف في وظيفة الدرقية فيعطي الثيروكسين حبه 50 ــ100 مكجم يوميا
- الاورام تستئصل بعمليه جراحية
- نقص اليود بعالج باعطاء مكملات اليود والماكولات البحرية
وإذا كان هناك صعوبة في التنفس أوالبلع بسبب كبر حجم الدرقية فينصح باجراء جراحه للتخلص من التضخم الحاصل .
اعداد ومراجعة د/ احمد الزهراني
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