{"id":2233,"date":"2026-02-27T10:10:26","date_gmt":"2026-02-27T10:10:26","guid":{"rendered":"https:\/\/www.innothyrogen.eu\/uncategorized-hr\/bolesti-stitnjace-simptomi-uzroci-dijagnoza-i-lijecenje\/"},"modified":"2026-02-27T10:16:40","modified_gmt":"2026-02-27T10:16:40","slug":"bolesti-stitnjace-simptomi-uzroci-dijagnoza-i-lijecenje","status":"publish","type":"post","link":"https:\/\/www.innothyrogen.eu\/hr\/blog\/bolesti-stitnjace-simptomi-uzroci-dijagnoza-i-lijecenje\/","title":{"rendered":"Bolesti \u0161titnja\u010de: simptomi, uzroci, dijagnoza i lije\u010denje"},"content":{"rendered":"\n

Kako \u0161titnja\u010da funkcionira i regulira hormone<\/strong><\/h2>\n\n

\u0160titnja\u010da je organ smje\u0161ten u donjem prednjem dijelu vrata. Glavna funkcija \u0161titnja\u010de je proizvodnja trijodtironina (T3) i tiroksina (T4). Hormoni \u0161titnja\u010de klju\u010dni su regulatori bazalne potro\u0161nje energije i metabolizma, pravilnog razvoja i diferencijacije stanica, neurorazvojnih procesa u prvim godinama \u017eivota, linearnog rasta, tjelesnog sastava i te\u017eine. Normalna funkcija \u0161titnja\u010de regulirana je hipotalami\u010dkim tirotropin-osloba\u0111aju\u0107im hormonom (TRH) koji poti\u010de osloba\u0111anje hormona koji stimulira \u0161titnja\u010du (TSH) iz hipofize. TSH pak poti\u010de sintezu i lu\u010denje hormona \u0161titnja\u010de iz \u0161titnja\u010de. Razine TSH-a i TRH-a pove\u0107avaju se kada su razine cirkuliraju\u0107ih hormona \u0161titnja\u010de niske, i obrnuto. Koncentracije TSH-a i slobodnog tiroksina (FT4) u serumu rutinski se koriste za procjenu funkcije \u0161titnja\u010de pojedinca u svakodnevnoj klini\u010dkoj praksi. Slobodni T3 ili slobodni T4 mjere aktivni hormon \u0161titnja\u010de koji nije vezan za protein i mo\u017ee utjecati na tjelesna tkiva. Ukupni T3 ili ukupni T4 mjere vezani i slobodni hormon, na \u0161to mogu utjecati razine proteina u krvi. Testovi koji mjere slobodne hormone to\u010dnije odra\u017eavaju kako \u0161titnja\u010da funkcionira. <\/p>\n\n

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\u010cesti poreme\u0107aji \u0161titnja\u010de: hipotireoza i hipertireoza<\/strong><\/h2>\n\n

Hipotireoza: uzroci, simptomi i lije\u010denje<\/h3>\n\n

Hipotireoza<\/strong> je stanje karakterizirano smanjenom proizvodnjom i lu\u010denjem hormona \u0161titnja\u010de. Kod primarne hipotireoze \u0161titnja\u010da ne mo\u017ee proizvesti odgovaraju\u0107e hormone \u0161titnja\u010de. Rje\u0111e vi\u0111ena sekundarna hipotireoza rezultat je abnormalne funkcije hipofize. Glavni pokazatelj hipotireoidnog stanja je niska razina hormona \u0161titnja\u010de i povi\u0161ena razina TSH-a. Naj\u010de\u0161\u0107i uzrok hipotireoze je Hashimotov tireoiditis. Pacijenti s hipotireozom zahtijevaju do\u017eivotnu nadomjesnu terapiju hormonima \u0161titnja\u010de levotiroksinom. Primarni cilj lije\u010denja je osigurati odgovaraju\u0107u dnevnu dozu hormona \u0161titnja\u010de kako bi se obnovila normalna funkcija \u0161titnja\u010de za svakog pojedina\u010dnog pacijenta. <\/p>\n\n

Hashimotov tireoiditis kao uzrok hipotireoze<\/h3>\n\n

Hashimotov tireoiditis<\/strong> je autoimuna bolest u kojoj disfunkcionalni imunolo\u0161ki sustav dovodi do kroni\u010dnog o\u0161te\u0107enja tkiva \u0161titnja\u010de, nakon \u010dega slijedi zamjena o\u0161te\u0107enih podru\u010dja o\u017eiljnim tkivom i limfocitima. Ova dijagnoza \u010de\u0161\u0107a je kod \u017eena, a njezina prevalencija raste s dobi. Bolest je karakterizirana pozitivnim protutijelima protiv tiroglobulina i peroksidaze \u0161titnja\u010de. Metabolizam se usporava zbog pada razine hormona. Pacijenti se naj\u010de\u0161\u0107e \u017eale na umor, slabu koncentraciju i pam\u0107enje, osjetljivost na hladno\u0107u, zatvor, debljanje, gubitak kose, lo\u0161e raspolo\u017eenje, osje\u0107aj gu\u0161enja ili stezanja u vratu te nedostatak motivacije. <\/p>\n\n

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Hipertireoza: simptomi, rizici i upravljanje<\/h3>\n\n

Hipertireoza<\/strong> je stanje prekomjerne proizvodnje i lu\u010denja hormona \u0161titnja\u010de u krv. Glavni pokazatelji su povi\u0161ene razine hormona \u0161titnja\u010de i smanjena razina TSH-a. Ubrzani metabolizam tvari i hranjivih sastojaka u tijelu mo\u017ee dovesti do razvoja drugih zdravstvenih problema nakon dugotrajnog razdoblja hipertireoze. U ve\u0107ini slu\u010dajeva uzrok hipertireoze je Basedow\u2013Gravesova bolest, ali drugi mogu\u0107i uzroci uklju\u010duju multinodularnu toksi\u010dnu gu\u0161u, toksi\u010dni adenom i upalu \u0161titnja\u010de. Nelije\u010dena hipertireoza mo\u017ee uzrokovati sr\u010dane aritmije, kongestivno zatajenje srca, osteoporozu, nepovoljne opstetri\u010dke ishode i metaboli\u010dke poreme\u0107aje poput pove\u0107ane potro\u0161nje energije u mirovanju i glukoneogeneze. Lije\u010denje treba biti usmjereno na pacijenta i individualizirano, uzimaju\u0107i u obzir dob, komorbiditete, te\u017einu hipertireoze, vjerojatnost remisije, planove za trudno\u0107u, dostupnu kirur\u0161ku stru\u010dnost i preferencije pacijenta. <\/p>\n\n

Basedow\u2013Gravesova bolest i autoimuna hipertireoza<\/h3>\n\n

Basedow\u2013Gravesova bolest<\/strong> je autoimuni poreme\u0107aj koji se \u010de\u0161\u0107e javlja kod mla\u0111ih \u017eena. Manifestira se difuznim pove\u0107anjem \u0161titnja\u010de, \u0161to mo\u017ee biti popra\u0107eno izbo\u010denjem o\u010diju. Obilje\u017eje bolesti je prisutnost protutijela protiv tiroglobulina, peroksidaze \u0161titnja\u010de i TSH receptora. Pacijenti se naj\u010de\u0161\u0107e \u017eale na lupanje srca, ubrzanu probavu, gubitak te\u017eine unato\u010d pove\u0107anom apetitu, osje\u0107aj vru\u0107ine i znojenje, nesanicu, promjene u menstrualnom ciklusu i seksualnoj \u017eelji, nervoznost i drhtanje ruku. Kod pacijenata s Gravesovom bole\u0161\u0107u lije\u010denje se treba usredoto\u010diti na kontrolu hipertireoze s o\u010dekivanom eventualnom remisijom Gravesove bolesti antitiroidnim lijekovima. Antitiroidni lijekovi smanjuju sintezu i lu\u010denje hormona \u0161titnja\u010de. Kod pacijenata koji ne postignu remisiju ili kod onih \u010dija hipertireoza u\u0111e u remisiju, a zatim se ponovi, treba razmotriti definitivnu terapiju radioaktivnim jodom ili tireoidektomijom. <\/p>\n\n

Multinodularna toksi\u010dna gu\u0161a i toksi\u010dni adenom<\/h3>\n\n

Multinodularna toksi\u010dna gu\u0161a<\/strong> je bolest karakterizirana vi\u0161estrukim \u010dvorovima u \u0161titnja\u010di koji lu\u010de hormone \u0161titnja\u010de prekomjerno bez regulacije hipofize. Toksi\u010dni adenom<\/strong> je vrsta benignog tumora koji na sli\u010dan na\u010din prekomjerno lu\u010di hormone \u0161titnja\u010de. Toksi\u010dna nodularna gu\u0161a i toksi\u010dni adenom uglavnom se lije\u010de radioaktivnim jodom ili tireoidektomijom. <\/p>\n\n

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Tumori \u0161titnja\u010de i rak \u0161titnja\u010de<\/h2>\n\n

Tumor je abnormalno nakupljanje tkiva. Tumori mogu biti benigni ili maligni. Etiologija karcinoma \u0161titnja\u010de nije u potpunosti razja\u0161njena. Me\u0111utim, poznato je da je ve\u0107i rizik prisutan kod \u017eena, osoba s obiteljskom anamnezom raka, onih koji su bili izlo\u017eeni zra\u010denju te da se \u010de\u0161\u0107e javlja nakon tridesete godine \u017eivota. <\/p>\n\n

Benigni tumori \u0161titnja\u010de: folikularni adenom<\/strong><\/h3>\n\n

Folikularni adenom<\/strong> je naj\u010de\u0161\u0107i epitelni benigni tumor. Javlja se u svim dobnim skupinama, ali \u010de\u0161\u0107e kod mladih odraslih osoba. To su solitarne, sferne tvorevine promjera manjeg od 3 cm. Adenomi mogu biti funkcionalni (toksi\u010dni) ili nefunkcionalni. Funkcionalni adenomi proizvode hormone \u0161titnja\u010de nekontrolirano, bez aktivacije hipofize. <\/p>\n\n

Maligni tumori \u0161titnja\u010de: vrste i mogu\u0107nosti lije\u010denja<\/h3>\n\n

Maligni tumori \u0161titnja\u010de vrlo su rijetki i \u010dine oko 1 % svih malignih tumora. Mogu biti diferencirani (papilarni i folikularni) ili nediferencirani (medularni i anaplasti\u010dni). Diferencirane tumorske stanice nalikuju normalnim stanicama tkiva. Tumori sastavljeni od takvih stanica bolje reagiraju na lije\u010denje. Nediferencirani tumori sastavljeni su od stanica koje ne nalikuju normalnom tkivu, pa se pona\u0161aju agresivnije i zahtijevaju agresivniji pristup lije\u010denju. Maligni tumori javljaju se ne\u0161to \u010de\u0161\u0107e kod \u017eena, obi\u010dno izme\u0111u 30. i 45. godine \u017eivota. Mogu\u0107nosti lije\u010denja odre\u0111ene su vrstom i stadijem raka \u0161titnja\u010de. Kirur\u0161ko uklanjanje \u0161titnja\u010de uobi\u010dajen je pristup. Sve preostale stanice raka zatim se lije\u010de terapijom radioaktivnim jodom. Nakon kirur\u0161kog uklanjanja \u0161titnja\u010de pacijenti moraju uzimati nadomjesnu terapiju hormonima \u0161titnja\u010de do kraja \u017eivota kako bi odr\u017eali normalne fiziolo\u0161ke procese. Vanjska terapija zra\u010denjem mo\u017ee biti opcija za osobe \u010diji agresivni ili uznapredovali tumori \u0161titnja\u010de ne reagiraju na standardnu skrb. <\/p>\n\n

Papilarni karcinom \u0161titnja\u010de<\/h3>\n\n

Papilarni karcinom<\/strong> je naj\u010de\u0161\u0107i rak \u0161titnja\u010de. Ova vrsta raka ima najbolju prognozu. \u010ce\u0161\u0107e se dijagnosticira prije 40. godine \u017eivota. Mo\u017ee ostati lokaliziran u \u017elijezdi godinama, ali kod nekih pacijenata metastaze u cervikalne limfne \u010dvorove ve\u0107 su prisutne u trenutku dijagnoze. <\/p>\n\n

Folikularni karcinom \u0161titnja\u010de<\/h3>\n\n

Folikularni karcinom<\/strong> je druga naj\u010de\u0161\u0107a vrsta raka \u0161titnja\u010de. Javlja se uglavnom kod osoba srednje i starije dobi. Ova vrsta raka agresivnija je od papilarnog karcinoma \u0161titnja\u010de, ali tako\u0111er ima dobru prognozu za oporavak. <\/p>\n\n

Medularni karcinom \u0161titnja\u010de<\/h3>\n\n

Medularni karcinom<\/strong> je rijetka vrsta raka \u0161titnja\u010de. Javlja se u srednjoj i kasnoj odrasloj dobi, obi\u010dno sporadi\u010dno kao solitarni \u010dvor \u0161titnja\u010de. Prognoza medularnog raka \u0161titnja\u010de obi\u010dno nije tako povoljna kao kod diferenciranih karcinoma \u0161titnja\u010de. <\/p>\n\n

Anaplasti\u010dni karcinom \u0161titnja\u010de<\/h3>\n\n

Anaplasti\u010dni karcinom<\/strong> je najrje\u0111i histolo\u0161ki tip raka \u0161titnja\u010de, ali je iznimno agresivan. U usporedbi s drugim vrstama karcinoma \u0161titnja\u010de, na\u017ealost ima najlo\u0161iju prognozu. <\/p>\n\n

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Trenutna istra\u017eivanja i napredak u lije\u010denju bolesti \u0161titnja\u010de<\/h2>\n\n

Budu\u0107i da su poreme\u0107aji \u0161titnja\u010de uvelike posljedica u\u017eurbanog na\u010dina \u017eivota, va\u017eno je uvesti neke promjene u svakodnevni \u017eivot pojedinca. U lije\u010denju bolesti \u0161titnja\u010de, osim lijekova, nagla\u0161ava se i va\u017enost pravilne prehrane. Prehrana treba biti raznolika i uravnote\u017eena, s \u010destim unosom teku\u0107ine. Ne postoji specifi\u010dna dijetetska terapija za probleme sa \u0161titnja\u010dom, ali preporu\u010duje se mediteranska prehrana jer se pokazala iznimno korisnom za \u0161irok raspon zdravstvenih problema. Va\u017eno je naglasiti va\u017enost konzumiranja minimalno prera\u0111ene hrane ili izbjegavanja industrijski pripremljene hrane koje ima u izobilju u trgovinama. Selen i selenoproteini va\u017eni su u stvaranju i metabolizmu hormona \u0161titnja\u010de. Imaju protuupalni u\u010dinak, mogu smanjiti titar protutijela peroksidaze \u0161titnja\u010de, pozitivno djeluju na hipotireozu i rezultiraju smanjenjem potrebne doze levotiroksina. <\/p>\n\n

Osim postoje\u0107ih dijagnosti\u010dkih metoda, provode se dodatna istra\u017eivanja u svrhu ranijeg otkrivanja bolesti, personalizirane medicine i boljih metoda lije\u010denja. Istra\u017euje se povezanost razli\u010ditih upalnih parametara s poreme\u0107ajima \u0161titnja\u010de kako bi poslu\u017eili kao dodatni dijagnosti\u010dki alati. Tako\u0111er se ispituje uklju\u010denost razli\u010ditih gena u bolesti \u0161titnja\u010de, \u0161to bi u budu\u0107nosti moglo biti korisno u personaliziranom pristupu pacijentima. Razvijeno je nekoliko me\u0111unarodnih sustava stratifikacije rizika \u010dvorova \u0161titnja\u010de temeljenih na ultrazvuku s ciljem smanjenja nepotrebnih biopsija. Istra\u017euju se manje invazivne alternative operaciji za rak \u0161titnja\u010de niskog rizika, poput aktivnog pra\u0107enja i minimalno invazivnih intervencija. Nove sustavne terapije sada su dostupne za pacijente s uznapredovalim rakom \u0161titnja\u010de. Napredak ciljane terapije i istra\u017eivanja biomarkera u raku \u0161titnja\u010de predstavlja mogu\u0107u promjenu u terapijskim metodama usmjerenim na preciznost i individualizaciju. <\/p>\n\n

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Autorica: Marija Banovi\u0107 (Poliklinika Leptir)<\/p>\n\n

Literatura<\/strong><\/p>\n\n

    \n
  1. Patil N, Rehman A, Anastasopoulou C, et al. Hypothyroidism. [Updated 2024 Feb 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519536\/ <\/li>\n\n\n\n
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  3. Guo M, Sun Y, Wei Y, Xu J and Zhang C. (2024) Advances in targeted therapy and biomarker research in thyroid cancer. Front. Endocrinol. 15:1372553. doi: 10.3389\/fendo.2024.1372553<\/li>\n\n\n\n
  4. Br\u010di\u0107 L, Bari\u0107 A, Gra\u010dan S, Brdar D, Torlak Lovri\u0107 V, Vidan N, Zemunik T, Pola\u0161ek O, Barbali\u0107 M, Punda A, Boraska Perica V. (2016): Association of established thyroid peroxidase autoantibody (TPOAb) genetic variants with Hashimoto’s thyroiditis, Autoimmunity, DOI: 10.1080\/08916934.2016.1191475<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Kako \u0161titnja\u010da funkcionira i regulira hormone \u0160titnja\u010da je organ smje\u0161ten u donjem prednjem dijelu vrata. Glavna funkcija \u0161titnja\u010de je proizvodnja trijodtironina (T3) i tiroksina (T4). Hormoni \u0161titnja\u010de klju\u010dni su regulatori bazalne potro\u0161nje energije i metabolizma, pravilnog razvoja i diferencijacije stanica, neurorazvojnih procesa u prvim godinama \u017eivota, linearnog rasta, tjelesnog sastava i te\u017eine. 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