UDkt. Theodore C. Friedman, MD, Ph.D. unguProfesa woMnyango wezokwelapha-UCLA, i-Endocrinology Division, futhi futhi ungumgogodoloji we-endocrinology emisebenzini yangasese. Ukuze uthole olunye ulwazi mayelana nomkhuba wakhe, bheka www.goodhormonehealth.com.
Kulesi sihloko, uhlanganyela ngemicabango yakhe mayelana nokuxilongwa kwe-hypothyroidism kanye nokwelapha.
I-Hypothyroidism Diagnosis
I-Hypothyroidism iyinkinga evamile.
Lithinta abesifazane abaningi bese kuthiwa amadoda, kodwa mina ngibona omunye wamadoda onayo. Izimpawu ze-hypothyroidism zihlanganisa ukukhathala, ukutholakala kancane kwesisindo somzimba, ukuqothulwa, imisipha yomzimba, ubuhlungu obuhlangene , ukuzwa okubandayo, ukungahambisani nomzimba, ubuthakathaka, ukulahlekelwa izinwele , owomile, isikhumba esibandayo kanye nesikhathi esincane sokuphendula. Iziguli eziningi zizoba ne-goiter (i-thyroid ekhulisiwe). Nakuba sekuthole ingxoxo enkulu, ngikholelwa ukuthi ukushisa komzimba okuphansi akuwona uphawu oluthembekile lwe-hypothyroidism.
Isimo se-hypothyroidism sanda ngokukhula kwesikhathi. Ngamanye amazwi, omdala esiwutholayo, cishe kunesifo se-thyroid esizovela. Isizathu esivame kakhulu se-primary hypothyroidism (i- hypothyroidism evela egunjini le-thyroid), yi-Hashimoto's Thyroiditis. I-Hashimoto sika isimo esizimele . Ama-antibodies omzimba ahlasela i-gland gland futhi ayibhubhise, eholela ku-hypothyroidism. I-Hashimoto's Thyroiditis ingase ibe ukubonakaliswa kwe-autoimmune syndromes eminingi futhi kungenzeka ibe emindenini.
I-Hypothyroidism ingabuye ibe ngenxa yenkinga ye-pituitary (central hypothyroidism).
Ukubona zonke izinhlobo ze-hypothyroidism kubalulekile, ngoba ukwelashwa nge-hormone ye-thyroid kuzothuthukisa izimpawu ezigulini ezine-hypothyroidism, kodwa akunakwenzeka ukusiza labo abangenayo i-hypothyroidism. Ku-hypothyroidism eyinhloko, isikhumba se-thyroid, esise entanyeni, asikwazi ukukhiqiza ama-hormone wegciwane , i-T4 ne-T3.
I-pituitary gland, ekhanda, isabela kulokhu kuntuleka ngokufihla i-TSH engaphezulu. Ngakho-ke, ezimweni ezinzima kakhulu ze-hypothyroidism eyinhloko, amazinga we-T4 ne-T3 ajwayelekile, kepha i-TSH iphakeme. Ezimweni ezimbi kakhulu, amazinga we-T4 ne-T3 awela. Nakuba uhla olujwayelekile lwe-TSH luvame ukuphakathi kuka-0.5 no-5 mU / mL, amanani ekupheleni okuphezulu kobubanzi obujwayelekile angase abe engavamile. I-T3 i-hormone engaphezu kwe-bioactive eqhathaniswa ne-T4, kodwa i-T4 igxilile kakhulu ekusakazeni.
Indlela yami yokuthola i- hypothyroidism ukuqala ngomlando oqaphile kanye nomzimba. Khona-ke i-Endocrinologist kufanele ihlole ukuhlolwa kwesifo socansi ukuze inqume ukuthi isiguli sinalo yini. I-Blood TSH, i-T4 yamahhala, i- T3 yamahhala namagciwane okulwa ne-TPO kufanele ahlolwe. Iziguli ezine-thyroid ekhulisiwe kanye / noma i-anti-TPO antibody test kanye ne-TSH enkulu kune-4.0 mU / mL kufanele ibhekwe ukuthi ine-hypothyroidism eyinhloko. Iziguli ezingenayo i-thyroid ekhulisiwe futhi ngaphandle kokuhlolwa okuhle kwe-anti-TPO antibody kodwa nge-TSH engaphezu kuka-7.5 mU / mL kufanele futhi kubhekwe ukuthi ine-primary hypothyroidism. Iziguli ezine-T4 yamahhala ezingaphansi kuka-0.9 mg / dL kanye ne-TSH engaphansi kuka-1.0 mU / mL cishe ziba ne-hypothyroidism ephakathi. Iziguli ezinezibonakaliso ze-hypothyroidism kodwa ezingahlangabezane nalezi zindlela kufanele zibukwe futhi ziphinde zithathwe ezinyangeni ezingu-6.
Ukwelashwa kwe-Hypothyroidism
Uma i-hypothyroidism itholakale, kunezinketho eziningi zokwelapha , kuhlanganise namalungiselelo wokwenziwa kokwenziwa kwe-L-thyroxine (T4) (Synthroid, Levoxyl ne-Unithroid), amalungiselelo okuhlanganiswa okuthiwa i-L-triiodothyronine (T3) (i-Cytomel), inhlanganisela yokwenziwa kwe-T4 / T3 (i-Thyrolar) neyenziwe Amalungiselelo e-thyroid (i-Armor, Naturethroid, i-Bio-Throid, ne-Westhroid). Wonke ama-L-thyroxine amalungiselelo aqukethe isithako esisebenzayo esifanayo, kodwa aqukethe ukugcwaliswa okuhlukile futhi abe nokulawula okuhlukile kwekhwalithi. Kuze kube yamuva, i-Synthroid ayinayo imvume ye-FDA, kodwa manje wonke amalungiselelo e-L-thyroxine anemvume ye-FDA.
I-thyrolar kanye namalungiselelo e-thyroid aphethwe cishe anezinga eliphakeme le-T3 / T4 kunesifiso futhi ngaleyo ndlela, ngivame ukunikeza inani eliphansi lala maqhinga ahlanganiswe ne-T4.
Abaningi be-endocrinologists basebenzisa ama-L-thyroxine amalungiselelo okuphathwa kokuqala kwazo zonke izinhlobo ze-hypothyroidism. Nakuba ukusebenzisa i-L-thyroxine (T4) kuqhathaniswa no-L-triiodothyronine (T3) kungase kusimangaze njengoba i-T3 iyimithi ye-thyroid ebizwa ngokuthi i-bioactive, i-T4 isetshenziswa njalo. Lokhu kungenxa yokuthi izicubu ziguqula i-T4 kuya ku-T3 ukugcina amazinga we-physiologic we-T3. Ngakho, ukuphathwa kwe-T4 kuphumela ku-T3 no-T4. Njengoba i-T4 igxilile ngaphezu kwe-T3, ukwelashwa kwe-T4 kunika ngisho namazinga egazi, kanti ukwelashwa kwe-T3 kuholela emazingeni aphezulu ngemuva kokuthatha imithi namazinga aphansi ngaphambi kwesilinganiso esilandelayo. Ukuvikela i-thyroid kungukulungiselela okubi kakhulu. Ngenxa yokuthi i-Armor yegciwane ifika ifomu yengulube ye-pig, ezinye ze-Endocrinologists zinomuzwa wokuthi kukhona iphilisi eliphakeme ekuphambeni kwepilisi, kodwa lokhu akunakwenzeka ukuba kube yiqiniso.
Ucwaningo olunyatheliswa eNew England Journal of Medicine ngo-1999 lwaphakamisa ukuthi ukuguqulwa kobuchopho T4 kuya eT3 ukuguqulwa kungahle kuphazamiseke kwezinye iziguli nokuthi iqembu elikhethiwe leziguli kufanele lilashwe nge- T4 no-T3 . Ezinye izifundo ezishicilelwe kuyi- Journal of Clinical Endocrinology kanye neMetabolism ngo-2003 ( bheka isihloko manje ) ziphakamisa ukuthi ukwengezwa kwe- T3 kuya eT4 ukwelashwa akudingeki iziguli eziningi ezine-hypothyroidism eyinhloko. Ngincoma ukuthi iziguli eziningi ziqale ukulungiswa kwe-T4, okuthuthukisa izimpawu eziningi kakhulu ezigulini. Ngithole ukuthi iziguli eziningi zikhetha i- Levoxyl noma i-Unithroid kuya ku-Synthroid , kodwa lokhu kuhluka nesiguli ngasinye. Ngemuva kokwelashwa kokuqala nge-T4, ngilungisa umthamo wabo we-T4 kuze kube yi-TSH yabo ephakathi kuka-0.5 no-2 mU / mL. Uma zihlala zibonisa uphawu naphezu kwe-TSH ehlelwe kahle, khona-ke ukulinganiselwa okuphansi kwe-T3 kunikezwe kabili noma kathathu ngosuku kungangenwa ngokucophelela ku-T4. Uma iziguli ziqala ngezinga eliphansi legazi elingenayo i-T3, khona-ke ngithandwa kakhulu ukuwaphatha nge-T4 kanye ne-T3. Ku-T4 kanye nokwelashwa kwe-T3 , ngisebenzisa ukuhlolwa kwegazi ukuqinisekisa ukuthi i-T4 yamahhala futhi i-T3 mahhala isendaweni ejwayelekile. Inani le-TSH livame ukususwa ngokuphathwa kokwenyuka .
Iphesenti leziguli zizobe zithuthukiswa ngokuphawulekayo ku-T4 kanye ne-T3 yokwelashwa. Kulabo abangathuthuki, ngezinye izikhathi ngincoma ukwelashwa ngamalungiselelo we-thyroid, okuvame ukuzivikela, kanye nokuhlanganiswa kwe-T4. Lokhu kuhlanganiswa kuyadingeka njengoba amalungiselelo e-thyroid ahlotshisiwe anezinga eliphakeme le-T3 / T4 kunesidingo futhi kudingeka adluliselwe nge-synthetic T4 ukuze afinyelele ububanzi obuvamile bama-hormone. Futhi, ngihlose i-T4 yamahhala futhi ngiyikhulula i-T3 ebangeni eliphezulu. Iziguli ezine-central hypothyroidism zingelashwa nganoma yimaphi amalungiselelo atholakalayo ezigulini ezine-primary hypothyroidism. Umehluko wukuthi ukwelashwa kudinga ukuqapha ngokuhloselela i-T4 yamahhala kanye ne-T3 mahhala ebangeni elivamile, njengoba i-TSH icindezelwe ngokuphathwa ngendlela efanele. Iziguli zombili eziphakathi nendawo eyinhloko hypothyroidism nazo zazidinga ukwelashwa ngokuhloselela i-T4 yamahhala futhi i-T3 mahhala kuhlu oluphezulu. Ngatholakala ukuthi ngine-primary hypothyroidism ngo-February 2003. I-endocrinologist yenza ukuhlolwa kwegciwane lami le-thyroid futhi ngathola ukuthi ngine-goiter. Amanani egazi lami abonise i-TSH ye-8 mU / mL kanye nama-anti-TPO anamandla kakhulu. Nginomlando oqinile wemindeni kaHashimotos Thyroiditis kodwa nginenhlanhla ukuba ngingabonakali kahle ngaphambi kokwelashwa. Manje ngingu-150 mg ngosuku lweLevoxyl, ngine-TSH ye-1.9 mU / mL futhi ngizizwa ngihle. Ngilahlekelwe amakhilogremu ambalwa ku-T4 yokwelapha futhi iphrofayela yami ye-cholesterol ithuthukisiwe.
Ishicilelwe ekuqaleni, ngo-2003