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  • 1 Jávorszky Ödön Kórház Izotóprészleg Vác Argenti Döme tér 1–3. 2600
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Három évvel ezelőtt kontinentális vezérelveket tettek közzé, amelyek a differenciált, kis kockázatú pajzsmirigyrákos betegek kezelésével és nyomon követésével foglalkoznak. Ezek az anyagok összegzik a változásokat és az új ajánlásokat. A nagy kockázatú betegeken más protokollt kell alkalmazni. A nyaki ultrahang fontos szerepet játszik a differenciáldiagnózisban és a kiújulások felderítésében. Az összefoglaló néhány új ultrahangos módszert is tárgyal. Az FDG-PET segít megoldani azoknak a betegeknek a problémáját, akiknél a szérum tireoglobulinszintje emelkedett, de a radiojódszken negatív volt. Az utóbbi években jelentősen bővültek ismereteink a pajzsmirigyrák patomechanizmusáról. A karcinogenezisben genetikus eltérések gyakran detektálhatók. Molekuláris módszerekkel a vékonytű-biopsziás aspirátumból a genetikus eseményeket ki lehet mutatni, és ez nemcsak a diagnózis, hanem a kezelés és a prognózis szempontjából is fontos. A diagnosztikus egésztest-szken helyett a terápia utánit részesítjük előnyben, bár a nagy kockázatú esetekben a diagnosztikus szken is hasznos információkat adhat. A pajzsmirigyrák elsődleges terápiája a megfelelő műtét: totális thyreoidectomia és nyirokcsomó-dissectio (ha szükséges) vagy kiválasztott esetekben a limitált műtét. Manapság a „radioguided” műtét javíthatja az eredményeket. A radiojódos rest ablatio biztonságos és hatékony a műtét kiegészítésében, csökkenti a relapsusok számát és hosszabb túlélést eredményez. Radiojód-kezelés előtt a tirotropin növelésére a pajzsmirigyhormon-megvonás vagy a rekombináns humán tireotropinstimuláció szolgál. A két módszer azonos hatékonyságú, de az exogén stimulációnál a vérdózis alacsonyabb, elkerülhető a hypothyreoid állapot és megmarad az életminőség. Amikor a tumorsejtek elvesztik fiziológiás funkciójukat, dedifferenciáció következik be. Ilyen esetekben terápiás cél a differenciált sejt néhány funkciójának, így a jódfelvétel, a peroxidáz és tireoglobulin-képzés reaktiválása. Ennek terápiás lehetőségeit tárgyaljuk. A jódfelvétel visszaállítása lehetővé teszi az izotópkezelést. Mostanáig csekély érdeklődés volt új gyógyszerek kifejlesztésére a pajzsmirigyrák kezelésében. A tumorsejtek biológiájának jobb megértése azonban paradigmaváltást okozott, és a nagy kockázatú betegek számára is terápiás lehetőségek nyíltak meg. Ezek a gyógyszerek már klinikai kipróbálás alatt állnak és hatékonyabbak, mint a korábbi citotoxikus ágensek. Az előrehaladott pajzsmirigyrák modern kemoterápiája valószínűleg már a közeljövőben eredményes lesz. Orv. Hetil., 2011, 152, 163–170.

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