Diferentovani karcinomi štitaste železde - epidemiologija, etiopatogeneza i terapijske smernice
Sažetak
Diferentovani karcinomi štitaste žlezde (DTC) čine više od 90 % svih tumora štitaste žlezde i obuhvataju papilarni i folikularni karcinom, čije ćelije imaju sposobnosti preuzimanja i koncentrisanja joda. U vreme postavljanja dijagnoze prosečna starost obolelih je 40 godina za papilarni, odnosno 50 godina za folikularni tireoidni karcinom. Osobe ženskog pola obolevaju 2-3 puta češće od muškaraca. Zračenje se smatra jednim od najvažnijih etioloških faktora za pojavu diferentovanih tireoidnih karcinoma, a naročito papilarnih karcinoma. DTC može biti i porodičnog karaktera kod oko 3% slučajeva. Pacijenti oboleli od DTC zahtevaju multidisciplinarni terapijski pristup što podrazumeva operativno lečenje, primenu radioaktivnog joda, kao i supresiju tireoidne funkcije. Aktuelna preporuka je totalna ili skoro totalna tireoidektomija sa postoperativnom primenom radiaktivnog joda 131 u cilju ablacije rezidualnog tumorskog ili normalnog tireoidnog tkiva, kao i u slučaju značajnog rizika od pojave recidiva bolesti. Nakon inicijalnog lečenja obolelih pacijenata, neophodan je njihov stalni nadzor, koji između ostalog uključuje i odredjivanje serumskih koncentracija tireoglobulina. Prognoza bolesti je uglavnom dobra, a desetogodišnje preživljavanje je preko 90%. Pojava recidiva prisutna je kod 10-15% obolelih, i to uglavnom u predelu vrata, limfnih čvorova ili tireoidne lože.
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