{"id":683,"date":"2025-05-12T13:21:00","date_gmt":"2025-05-12T10:21:00","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=683"},"modified":"2025-05-12T13:21:03","modified_gmt":"2025-05-12T10:21:03","slug":"yaslilarda-tiroid-hastaliklari-tani-ve-tedavide-ipuclari","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-tiroid-hastaliklari-tani-ve-tedavide-ipuclari\/","title":{"rendered":"Ya\u015fl\u0131larda Tiroid Hastal\u0131klar\u0131, Tan\u0131 Ve Tedavide \u0130pu\u00e7lar\u0131"},"content":{"rendered":"\n

Yazar: Do\u00e7. Dr. Vahide Asl\u0131han DURAK<\/strong><\/p>\n\n\n\n

Edit\u00f6r: Do\u00e7. Dr. Canan AKMAN<\/strong><\/p>\n\n\n\n

Tiroid hastal\u0131klar\u0131, ya\u015fl\u0131 bireylerde s\u0131k kar\u015f\u0131la\u015f\u0131lan endokrinolojik sorunlar aras\u0131nda yer almakta olup, bu ya\u015f grubunda tan\u0131 ve tedavi s\u00fcre\u00e7leri gen\u00e7 eri\u015fkinlere g\u00f6re belirgin farkl\u0131l\u0131klar g\u00f6stermektedir.<\/p>\n\n\n\n

Ya\u015flanmayla birlikte tiroid bezinin yap\u0131sal ve fonksiyonel de\u011fi\u015fikliklere u\u011framas\u0131, atipik semptomlarla ba\u015fvurulara neden olmaktad\u0131r. Yorgunluk, kilo al\u0131m\u0131 veya kayb\u0131, bili\u015fsel gerileme ve kardiyovask\u00fcler bulgular gibi non-spesifik \u015fikayetlerle ba\u015fvuran ya\u015fl\u0131 hastalarda tiroid disfonksiyonlar\u0131n\u0131n ay\u0131r\u0131c\u0131 tan\u0131da mutlaka g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gerekmektedir (1)<\/p>\n\n\n\n

Ayr\u0131ca, ya\u015fl\u0131 bireylerde e\u015flik eden komorbid hastal\u0131klar ve kullan\u0131lan ila\u00e7lar, tiroid hastal\u0131klar\u0131n\u0131n hem klinik g\u00f6r\u00fcn\u00fcm\u00fcn\u00fc hem de tedavi yakla\u015f\u0131m\u0131n\u0131 etkilemektedir. Bu nedenle, ya\u015fl\u0131 pop\u00fclasyonda tiroid hastal\u0131klar\u0131n\u0131n tan\u0131, tedavi ve izlem s\u00fcrecinde \u00f6zel bir dikkat ve multidisipliner yakla\u015f\u0131m gereklidir (2).<\/p>\n\n\n\n

Bu yaz\u0131m\u0131zda, ya\u015fa ba\u011fl\u0131 tiroid fonksiyonlar\u0131ndaki de\u011fi\u015fimler, ba\u015fl\u0131ca tiroid hastal\u0131klar\u0131n\u0131n klinik \u00f6zellikleri ve g\u00fcncel tedavi yakla\u015f\u0131mlar\u0131 ele al\u0131nacakt\u0131r.<\/p>\n\n\n\n

Tiroid bezinin ya\u015fa ba\u011fl\u0131 anatomik ve fizyolojik de\u011fi\u015fimi<\/strong><\/p>\n\n\n\n

\u0130lerleyen ya\u015f ile tiroid bezinin hacmi; atrofi ve fibrozise ba\u011fl\u0131 olarak azalmakta olup bu durum fizik muayene esnas\u0131nda palpasyonunu zorla\u015ft\u0131rabilmektedir. Bir di\u011fer \u00f6nemli nokta ise tiroid bezinin daha nod\u00fcler yap\u0131da olabilece\u011fi ve neoplastik lezyonlar\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131n\u0131n artaca\u011f\u0131d\u0131r. Endokrin a\u00e7\u0131dan bak\u0131ld\u0131\u011f\u0131nda ise hipotalamus-hipofiz-tiroid aks\u0131n\u0131n geriatrik grupta korunmu\u015f oldu\u011fu ancak iyot d\u00fczeyinin diyete ba\u011fl\u0131 k\u0131s\u0131tlamalarla (altta yatan hipertansiyon, kalp hastal\u0131\u011f\u0131 ve renal hastal\u0131klar) azalm\u0131\u015f oldu\u011fu g\u00f6r\u00fclmektedir (1,3)<\/p>\n\n\n\n

Literat\u00fcrde yer alan \u00e7al\u0131\u015fmalarda tiroid bezinin ya\u015fa ba\u011fl\u0131 de\u011fi\u015fimleri Tiroid stim\u00fcle edici hormon (TSH), triiodotronin (T3), tetraiodotronin (T4), rT3, Tiroglobulin ve Tiroperoksidaz (TPO) d\u00fczeyleri \u00fczerinden incelenmi\u015ftir (1,2)<\/p>\n\n\n\n

TSH d\u00fczeyinin ya\u015fa ba\u011fl\u0131 de\u011fi\u015fim g\u00f6sterdi\u011fi yap\u0131lan \u00e7al\u0131\u015fmalar ile saptansa da literat\u00fcrde bu konu ile ilgili net bir sonu\u00e7 yer almamaktad\u0131r. TSH d\u00fczeyinin ya\u015fa ba\u011fl\u0131 artt\u0131\u011f\u0131n\u0131 g\u00f6steren \u00e7al\u0131\u015fmalar\u0131n (4,5) yeterli iyot al\u0131m\u0131 olan pop\u00fclasyonlarda y\u00fcr\u00fct\u00fcld\u00fc\u011f\u00fc g\u00f6r\u00fclmekte olup, iyot al\u0131m\u0131 s\u0131n\u0131rda olan toplumda y\u00fcr\u00fct\u00fclen bir \u00e7al\u0131\u015fmada (6) ise TSH d\u00fczeyinin hi\u00e7 artmad\u0131\u011f\u0131 aksine azalma e\u011filiminde oldu\u011fu g\u00f6r\u00fclmektedir.<\/p>\n\n\n\n

Geriatrik grupta polifarmasiye ba\u011fl\u0131 olarak da TSH d\u00fczeyinde de\u011fi\u015fim g\u00f6r\u00fclebilmektedir. Metformin, dopamin antagonistleri, glukokortikoidler, somatostatin analoglar\u0131, proton pompa inhibit\u00f6rleri , anti-epileptik ila\u00e7lar ve lityum kullan\u0131m\u0131 bu etkiyi sa\u011flayan ila\u00e7lar aras\u0131nda yer almaktad\u0131r.<\/p>\n\n\n\n

TSH d\u00fczeyi i\u00e7in ya\u015fa ba\u011fl\u0131 adapte edilebilen referans de\u011ferler kabul edilmesi halen tart\u0131\u015fmal\u0131 bir konu olup daha fazla prospektif \u00e7al\u0131\u015fmaya ihtiya\u00e7 duyulmaktad\u0131r. Literat\u00fcrde yer alan \u00e7al\u0131\u015fmalarda serbest T4 ve T3 d\u00fczeyinde ya\u015fa ba\u011fl\u0131 azalma oldu\u011fu g\u00f6r\u00fclmektedir (1) TPO ve tiroglobulin antikorlar\u0131n\u0131n d\u00fczeyi ya\u015fa ba\u011fl\u0131 artmakta olup tiroid ba\u011flay\u0131c\u0131 globulin d\u00fczeyi ise azalmaktad\u0131r. Bu sebeple geriatrik hasta grubunda serbest tiroid hormonlar\u0131n\u0131n \u00f6l\u00e7\u00fcm\u00fcn\u00fcn daha faydal\u0131 olaca\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir (1,7)<\/p>\n\n\n\n

Hipotiroidi<\/strong><\/p>\n\n\n\n

Primer hipotiroidi, TSH d\u00fczeyinde artma (10 mIU\/L ve \u00fczeri ) ile birlikte dola\u015f\u0131mdaki serbest T3 ve serbest T4 d\u00fczeylerinde azalma\/sabit kalma olarak tan\u0131mlanmakta olup 65 ya\u015f ve \u00fczerindeki hastalarda mortalite art\u0131\u015f\u0131 ve kardiyovask\u00fcler olaylar\u0131n art\u0131\u015f\u0131 ile ili\u015fkilendirilmektedir. Bu sebeple erken ve do\u011fru tan\u0131 son derece \u00f6nemlidir.<\/p>\n\n\n\n

Hipotiroidi subklinik veya primer olarak g\u00f6r\u00fclebilmektedir. Primer hipotiroidi i\u00e7in toplumda g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %0,3 olup geriatrik grupta ise bu oran %9\u2019lara ula\u015fabilmekte ve kad\u0131n cinsiyette g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 artmaktad\u0131r (1) Subklinik hipotiroidi ise geriatrik grupta %15 oran\u0131nda g\u00f6r\u00fclebilmektedir.<\/p>\n\n\n\n

Etiyolojide tiroid bezinin hastal\u0131klar\u0131, santral nedenler ve metastaz gibi daha nadir nedenler yer almaktad\u0131r. Geriatrik grupta subklinik hipotiroidi ve ya\u015fa ba\u011fl\u0131 fizyolojik de\u011fi\u015fimlerin ayr\u0131m\u0131n\u0131 yapmak son derece \u00f6nemlidir. T\u00fcm ya\u015f gruplar\u0131nda bak\u0131ld\u0131\u011f\u0131nda \u00e7evresel iyot eksikli\u011fi en s\u0131k etken olup ya\u015fl\u0131larda otoimm\u00fcn tiroidit (Hashimato tiroiditi), cerrahi (tiroidektomi) ve medikal prosed\u00fcrler (radyasyon tedavisi) ve ila\u00e7 kullan\u0131m\u0131na ba\u011fl\u0131 hipotiroidi mutlaka ak\u0131lda tutulmal\u0131d\u0131r (1).<\/p>\n\n\n\n

Hipotiroidinin klasik bulgular\u0131 olan so\u011fuk intolerans\u0131, kilo art\u0131\u015f\u0131 ve parestezi geriatrik grupta g\u00f6r\u00fclmeyebilmektedir. Yorgunluk, ba\u015f d\u00f6nmesi, haf\u0131za kayb\u0131 ve kognitif fonksiyonlarda gerileme, makrositik anemi ve kab\u0131zl\u0131k ya\u015fl\u0131larda s\u0131k g\u00f6r\u00fclen bulgulard\u0131r. Erken tan\u0131 ve tedavi ile hepsi geri d\u00f6nd\u00fcr\u00fclebilmekte oldu\u011fu i\u00e7in klinisyenler her zaman dikkatli olmal\u0131d\u0131r. Anamnezde ailede tiroid hastal\u0131\u011f\u0131 \u00f6yk\u00fcs\u00fc, ge\u00e7irilmi\u015f cerrahi, boyun b\u00f6lgesine radyoterapi, pernisy\u00f6z anemi, depresyon, hipertansiyon, Amiodoron ve Lityum kullan\u0131m\u0131, QT uzamas\u0131, konjestif kalp yetmezli\u011fi, adrenal yetmezlik mutlaka sorgulanmal\u0131 ve hastalar\u0131n TSH d\u00fczeyi g\u00f6r\u00fclmelidir. Tan\u0131da serbest T3 ve serbest T4 d\u00fczeyleri \u00f6nemlidir. Primer hipotiroidide y\u00fcksek TSH ve d\u00fc\u015f\u00fck serbest T4 d\u00fczeyi g\u00f6r\u00fclmektedir (1)<\/p>\n\n\n\n

Hipotiroidi tan\u0131s\u0131 sonras\u0131 hastalar\u0131n tedavisi mutlaka ba\u015flanmal\u0131d\u0131r. Amerikan Klinik Endokrin Birli\u011fi TSH de\u011feri 10 mIU\/L \u00fczerindeki geriatrik hastalarda ila\u00e7 tedavisini (levotiroksin) \u00f6nermektedir. Gen\u00e7 hastalara k\u0131yasla %20-25 daha d\u00fc\u015f\u00fck oranda doz (12.5- 25 mcg) ile tedaviye ba\u015flanmakta olup kademeli artt\u0131r\u0131lmal\u0131d\u0131r. Triiodotronin ile kombine levotiroksin tedavisi kardiyovask\u00fcler risklerden dolay\u0131 geriatrik hastalarda \u00f6nerilmemektedir. Doz a\u015f\u0131m\u0131n\u0131n hastalarda; \u00e7arp\u0131nt\u0131, atriyal fibrilasyon, anjina, kemik erimesi ve mental durum de\u011fi\u015fikli\u011fine yol a\u00e7aca\u011f\u0131 unutulmamal\u0131d\u0131r (1).<\/p>\n\n\n\n

Subklinik hipotiroidi; TSH y\u00fcksekli\u011fi (4.5 mIU\/L ve \u00fczeri) ve normal serbest T4 d\u00fczeyi ile karakterizedir. Hastalara 3-6 ayl\u0131k d\u00f6ng\u00fclerde tiroid fonksiyon testleri bak\u0131lmal\u0131 ve depresyon \u015fik\u00e2yeti ile ba\u015fvuran geriatrik hastalarda subklinik hipotiroidi mutlaka ak\u0131lda tutulmal\u0131d\u0131r. Tedavi ba\u015flanmas\u0131 ve faydalar\u0131 ise halen tart\u0131\u015fmal\u0131 bir alan olup bu konuda daha fazla \u00e7al\u0131\u015fmaya ihtiya\u00e7 vard\u0131r (8,9)<\/p>\n\n\n\n

Hipertiroidi<\/strong><\/p>\n\n\n\n

Hipertiroidi; geriatrik hasta pop\u00fclasyonunda atipik bulgularla prezente olabilmekte ve \u00e7o\u011fu zaman atlanabilmektedir. G\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %1,2 civar\u0131nda iken ileri ya\u015f grubunda bu oran %0,5 ile 3 oran\u0131nda de\u011fi\u015febilmektedir. Primer hipertiroidi; TSH d\u00fczeyinde azalma, serbest T3 ve\/veya serbest T4 d\u00fczeyinde artma ile tan\u0131mlanmaktad\u0131r (1)<\/p>\n\n\n\n

Geriatrik grupta hipertiroidi i\u00e7in en s\u0131k neden Graves hastal\u0131\u011f\u0131 olup ya\u015fla beraber multinod\u00fcler guatr ve toksik nod\u00fcl say\u0131s\u0131n\u0131n da artt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Etyolojide rol oynayan nedenler; iyot i\u00e7eren kontrastl\u0131 radyolojik i\u015flemler, Quervain tiroiditi, struma ovari ve y\u00fcksek doz ila\u00e7 ( levotiroksin, amiodoron) al\u0131m\u0131d\u0131r (10)<\/p>\n\n\n\n

Klinik bulgular di\u011fer ya\u015f gruplar\u0131ndan farkl\u0131l\u0131k g\u00f6sterebilmektedir. Yeni ba\u015flayan atriyal fibrilasyon (geriatrik ya\u015f grubunda hipertiroidinin tek bulgusu olabilir), anjina, kalp yetmezli\u011fi, kilo kayb\u0131, ilerleyen osteoporoz (kal\u00e7a k\u0131r\u0131\u011f\u0131 riskinde 3 kat, vertebra k\u0131r\u0131\u011f\u0131 riskinde ise 4 kat art\u0131\u015f), yara iyile\u015fmesinde gecikme, apati, depresyon ve kab\u0131zl\u0131k bu ya\u015f grubunda g\u00f6r\u00fclen atipik bulgulard\u0131r (11,12).<\/p>\n\n\n\n

Apatik tirotoksikoz geriatrik hasta grubunda %40 oran\u0131nda g\u00f6r\u00fclmekte olup hastalar; halsizlik, ilgisizlik, kilo kayb\u0131, konf\u00fczyon ve kab\u0131zl\u0131k ile ba\u015fvurdu\u011funda mutlaka \u00f6n tan\u0131da d\u00fc\u015f\u00fcn\u00fclmelidir (13,14).<\/p>\n\n\n\n

Tan\u0131da ba\u015flang\u0131\u00e7 testi olarak TSH d\u00fczeyi istenmelidir. Takiben serbest T4, serbest T3, tirotropin resept\u00f6r antikoru ve tiroid ultrasonu da eklenebilir. Multivitaminlerde yer alan y\u00fcksek doz biotin kullan\u0131m\u0131na ba\u011fl\u0131 olarak hastalarda Graves sendromunu taklit eden bulgular g\u00f6r\u00fclebilmekte ve hastalar\u0131n ila\u00e7 ve vitamin kullan\u0131m\u0131 anamnezde mutlaka sorgulanmal\u0131d\u0131r (1).<\/p>\n\n\n\n

Amiodoron ili\u015fkili tirotoksikozda ise T4 d\u00fczeyinde artma g\u00f6r\u00fcl\u00fcrken T3 d\u00fczeyinde artma g\u00f6r\u00fclmemektedir (15).<\/p>\n\n\n\n

Subklinik hipertiroidi geriatrik grupta %5-10oran\u0131nda g\u00f6r\u00fclmekte olup; d\u00fc\u015f\u00fck d\u00fczeyde TSH ve normal serbest T4 d\u00fczeyi ile karekterizedir. \u0130leri ya\u015f kad\u0131nlarda ve iyot eksikli\u011fi olan b\u00f6lgelerde ise daha s\u0131k olarak g\u00f6r\u00fclmektedir. Tedavi almayan hastalar; a\u015fik\u00e2r hipertiroidi, kardiyovask\u00fcler etkiler (atriyal fibrilasyon, kalp yetmezli\u011fi) ve osteoporoz a\u00e7\u0131s\u0131ndan risk alt\u0131nda olup tedaviye ba\u015flama karar\u0131 bireysel riskler g\u00f6zetilerek planlanmal\u0131d\u0131r (16).<\/p>\n\n\n\n

Hipertiroidi tedavisinde \u00f6nemli noktalar; semptomlar\u0131n kontrol\u00fc ve tiroid hormon sentezinin azalt\u0131lmas\u0131d\u0131r. Beta blok\u00f6r tedavisi ile kalp h\u0131z\u0131 ve sistolik kan bas\u0131nc\u0131n\u0131n kontrol alt\u0131na al\u0131nmas\u0131na ek olarak, tremor, irritabilite, duygusal dengesizlik ve egzersiz intolerans\u0131 da tedavi edilebilmektedir. Graves hastal\u0131\u011f\u0131 tedavisinde ise; anti-tiroid ila\u00e7lar, radyoaktif iyot tedavisi ve cerrahi tiroidektomi yer almakta olup tedavi planmas\u0131 bireysel durum g\u00f6zetilerek yap\u0131lmal\u0131d\u0131r. Geriatrik grup hastalar\u0131n yan etkiler ve rek\u00fcrrens a\u00e7\u0131s\u0131ndan risk alt\u0131nda oldu\u011fu unutulmamal\u0131d\u0131r. Hastalar\u0131n 2-6 haftal\u0131k periyotlarla hormon d\u00fczeyi \u00f6l\u00e7\u00fcmleri yap\u0131lmal\u0131d\u0131r. Radyoaktif iyot tedavisi; etkinlik, g\u00fcvenlik ve maliyet a\u00e7\u0131s\u0131ndan etkin oldu\u011fundan bu grup hastalarda tercih edilmekte iken cerrahi tedaviler (obstr\u00fcktif semptomlara neden olan malignite varl\u0131\u011f\u0131 hari\u00e7) ya\u015fa ba\u011fl\u0131 komorbid durumlardan \u00f6t\u00fcr\u00fc s\u0131kl\u0131kla tercih edilmemektedir (1)<\/p>\n\n\n\n

Tiroid f\u0131rt\u0131nas\u0131<\/strong><\/p>\n\n\n\n

Tiroid f\u0131rt\u0131nas\u0131, nadir g\u00f6r\u00fclen ve ya\u015fam\u0131 tehdit eden klinik bir durum olup tirotoksikoz bulgular\u0131 ile karekterizedir. Geritarik grupta uzun s\u00fcre tedavi almayan hipetiroidili hastalarda; cerrahi, travma, enfeksiyon ve amiodoron kullan\u0131m\u0131 sonucu tetiklenebilmektedir. Ate\u015f y\u00fcksekli\u011fi, ajitasyon, anksiyete, deliryum, psikoz, ta\u015fikardi, hipotansiyon, aritmiler, stupor ve koma tablosu ile ba\u015fvuran hastalarda mutlaka gelmesi gereken bir \u00f6n tan\u0131 olup, TSH, serbest T3 ve T4 d\u00fczeyleri mutlaka istenmelidir. Tedavide beta blok\u00f6rler, tionamidler, iyot ve glukokortikoidler \u00f6nerilmekte olup bu hastalar\u0131n olas\u0131 komplikasyonlar a\u00e7\u0131s\u0131ndan yo\u011fun bak\u0131mda yak\u0131n izlemi son derece \u00f6nemlidir (17,18).<\/p>\n\n\n\n

Tiroid nod\u00fclleri ve malignite<\/strong><\/p>\n\n\n\n

Geriatrik pop\u00fclasyonda tiroid nod\u00fcllerinin g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 iyot miktar\u0131 yeterli b\u00f6lgelerde ya\u015fayan kad\u0131n cinsiyet i\u00e7in %5, erkek cinsiyet i\u00e7in ise %1 oran\u0131nda saptanm\u0131\u015ft\u0131r. Ultrason incelemesinde ise yakla\u015f\u0131k %50 hastada tiroid nod\u00fcl\u00fc saptanmakta olup bunlar\u0131n malign karekterde olmas\u0131 ise %4-6.5 aras\u0131ndad\u0131r. Malignite i\u00e7in risk fakt\u00f6rleri; ileri ya\u015fta erkek cinsiyet, devam eden disfaji, dispne varl\u0131\u011f\u0131, servikal adenopati, radyasyon maruziyeti \u00f6yk\u00fcs\u00fc ve ailesel \u00f6yk\u00fc olmas\u0131d\u0131r. Geriatrik grupta en s\u0131k g\u00f6r\u00fclen; iyi diferansiye papiller tiroid kanseri olup yava\u015f b\u00fcy\u00fcyen ve boyunda a\u011fr\u0131s\u0131z kitle ile ba\u015fvuran hastalarda mutlaka d\u00fc\u015f\u00fcn\u00fclmelidir. 1 cm ve \u00fczeri nod\u00fcller malignite a\u00e7\u0131s\u0131ndan riskli kabul edilirken, 1cm alt\u0131 nod\u00fcller ek bulgu varl\u0131\u011f\u0131 ve lenfadenopati varl\u0131\u011f\u0131nda ara\u015ft\u0131r\u0131lmal\u0131d\u0131r (19).<\/p>\n\n\n\n

Anaplastik tiroid kanseri agresif bir t\u00fcr olup 80 ya\u015f \u00fczerinde s\u0131kl\u0131\u011f\u0131 artmakta ve ba\u015fvuru an\u0131nda boyunda kitle ile beraber olan metastazlar ile tan\u0131s\u0131 konulmaktad\u0131r (20,21).<\/p>\n\n\n\n

Tan\u0131sal basamaklar di\u011fer ya\u015f gruplar\u0131 ile benzer basamaklar\u0131 i\u00e7ermekte olup; anamnezde rasyasyon maruziyeti ve aile \u00f6yk\u00fcs\u00fc mutlaka sorgulanmal\u0131d\u0131r. Fizik muayenede servikal lenf nodlar\u0131n\u0131n palpasyonu, nod\u00fcl\u00fcn \u00e7evre dokulara fiksasyonu ve ses k\u0131s\u0131kl\u0131\u011f\u0131 malignite lehine bulgular olarak de\u011ferlendirilmelidir. Tiroid bezinin ultrason ile de\u011ferlendirilmesi, serum TSH ve tiroid oto-antikor \u00f6l\u00e7\u00fcm\u00fc yap\u0131lmal\u0131d\u0131r. Benign karekterde ancak boyutlar\u0131 4cm ve \u00fczeri olan nod\u00fcllerde, malignite olas\u0131l\u0131\u011f\u0131n\u0131n artmas\u0131 sebebi ile cerrahi \u00f6nerilmektedir. Cerrahi sonras\u0131 radyoaktif iyot ise; boyutlar\u0131 4 cm ve \u00fczeri olan (metastaz yoklu\u011funda) ve metastaz yapan t\u00fcm\u00f6rlerde verilmektedir. Bu a\u015famalar\u0131 takiben hastalara; levotiroksin tedavisi ba\u015flanmal\u0131 ve hipofizden sal\u0131nan TSH sal\u0131n\u0131m\u0131n\u0131 bask\u0131lamas\u0131 hedeflenmektedir (1).<\/p>\n\n\n\n

Sonu\u00e7 olarak; geriatrik grupta tiroid hastal\u0131klar\u0131n\u0131n y\u00f6netimi son derece dikkatli bir \u015fekilde planlanmal\u0131 ve di\u011fer ya\u015f gruplar\u0131ndan farkl\u0131 klinik tablolarla ba\u015fvurabilecekleri unutulmamal\u0131d\u0131r. Polifarmasi ve komorbid hastal\u0131klar mutlaka sorgulanmal\u0131 ve tedavi a\u015famas\u0131nda ila\u00e7 dozlar\u0131n\u0131n ayarlanmas\u0131 konusunda da hassasiyet g\u00f6sterilmelidir.<\/p>\n\n\n\n

Kaynaklar<\/strong><\/p>\n\n\n\n

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21-Rao SN, Smallridge RC. Anaplastic thyroid cancer: An update. Best Pract Res Clin Endocrinol Metab<\/em>. 2023;37(1):101678. doi:10.1016\/j.beem.2022.101678<\/p>\n","protected":false},"excerpt":{"rendered":"

Yazar: Do\u00e7. Dr. Vahide Asl\u0131han DURAK Edit\u00f6r: Do\u00e7. Dr. Canan AKMAN Tiroid hastal\u0131klar\u0131, ya\u015fl\u0131 bireylerde s\u0131k kar\u015f\u0131la\u015f\u0131lan endokrinolojik sorunlar aras\u0131nda yer almakta…<\/p>\n","protected":false},"author":1185,"featured_media":686,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10042,10055,10018,10054],"class_list":["post-683","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil","tag-endokrin","tag-geriatri","tag-tiroid"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/683","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=683"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/683\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/686"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=683"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=683"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=683"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}