Sekuyiminyaka engaphezu kwengu-40, indlela evamile yokwelapha i-hypothyroidism bekulokhu ukuhlinzeka nge-thyroid i-hormone esikhundleni somuthi we- levothyroxine (okungukuthi, i-Synthroid, i-Levoxyl); ngenhloso yokuqinisekisa ukuthi izinga le-TSH lingena ebangeni lokubhekisela. Lokhu kuye kwacatshangwa ukuthi ukwelashwa okugcwele kwalesi simo.
Inkolelo yale ndlela yokwelapha evamile yukuthi ukwelashwa nge-levothyroxine-ifomu le-thyroxine (T4) elikhiqizwa yi-gland yegciwane-lizohlinzeka nge-T4 eyanele, libuyisele umsebenzi ovamile we -roid-outhyroidism-futhi uxazulule yonke imithi ye-thyroid- izimpawu ezihlobene.
Ochwepheshe abaningi abaholayo, kuhlanganise nomuntu ovelele we-endocrinologist uDkt. Anthony Weetman , baye bathi ngisho neziguli "ezinezivivinyo ezivamile ze-thyroid" kodwa ziphikelela ukuthi kufanele ziphathwe izimpawu eziningi ze -roid noma eziqhubekayo izimpawu zinezifo "ze-somatoform". (Izimpikiswano ze-Somatoform zichazwa ezinchazamazwi zezokwelapha ngokuthi "izifo ezingokwengqondo ezikhonjiswe izikhalazo ezingokomzimba, okungekho incazelo yezinto eziphilayo noma ezokuphila ezitholakala futhi okungenzeka ukuthi kunezici ezingokwengqondo ezithintekayo.")
I-gland evamile yegciwane ikhiqiza ama-hormone ayisihluthulelo amaningi, kuhlanganise ne-hormone yokugcina thyroxine (T4) ne-hormone esebenzayo triiodothyronine (T3). Iningi lama-hormone akhiqizwa ngu-T4, kodwa i-T4 kumele iguqulwe emzimbeni ibe yi-hormone esebenzayo ye-T3 ukuze ibe nethonya emzimbeni wakho. Imfundiso eqinile futhi ephumelelayo yukuthi i-hypothyroidism kufanele iphathwe kuphela nge-levothyroxine-ngezinye izikhathi ibizwa ngokuthi i-LT4 monotherapy noma i-levothyroxine monotherapy-kumazinga okwenza ukuba ube yi-euthyroid, namazinga akho e-TSH awela ngaphansi kwebala lokubhekisela.
Le mfundiso ithi uma kune-T4 eyanele, umzimba uzohlala uyenzela ngokwanele i-T3.
Naphezu kokubaluleka kwalolu kholo lwemithi ejwayelekile, iziguli eziningana ze-thyroid ziye zavame ukukhuluma ngokulinganiselwa kwe-levothyroxine ekuxazululeni izimpawu zabo. Abacwaningi balinganisela ukuthi iziguli ezingu-15% ziyaqhubeka nokuzwa izimpawu ezinzima ze-hypothyroidism naphezu kokwelashwa kwe-levothyroxine.
Ucwaningo lweziguli ze-thyroid lisikisela ukuthi inani liphakeme kakhulu .
Ukuthola Okuseshweni
Ukuhlola ukuthi ngabe ukubuyisela izinga le-TSH ebangeni lokubhekisela ngokusebenzisa i-levothyroxine laphumelela, abacwaningi e-Rush University Medical Center e-Chicago benza ucwaningo ngokuqhathanisa neqembu elilawulayo labantu abaphilile, abangenayo ubufakazi besifo segciwane, ngokumelene neqembu labantu babephathwa nge-levothyroxine ye-hypothyroidism. Imiphumela yabika ngo-Okthoba 2016 umagazini we- Journal of Clinical Endocrinology kanye noMetabolism .
Imiphumela yayimangalisa kakhulu. Ucwaningo lwathola ukuthi:
- Iqembu le-levothyroxine elaphethwe yi-levothyroxine lalinamaphesenti angama-20 aphezulu e-TSH, amaphesenti angu-10 angaphansi kwamazinga we-T3, nama-15% aphansi amazinga T3 uma kuqhathaniswa neqembu lokulawula.
- Iqembu le-levothyroxine elaliphathwe kabi linomhlahlandlela womzimba ophakeme, nakuba babika ukuthi badla amakhilogremu ambalwa ngosuku. Balinganiselwa ngaphezulu kwamakhilogremu angu-10, naphezu kokudla ama-khalori ambalwa ngosuku.
- Iqembu le-levothyroxine elaphashwa laliphindwe izikhathi ezingu-1.6 ukuba ithathe i-beta-blockers, ejwayele ukusetshenziselwa ukwelapha izinga eliphezulu legazi.
- Iqembu le-levothyroxine elaphashwa laliphindaphindiwe izikhathi ezingu-1.5 zokuthatha izidakamizwa ze-statin, ezisetshenziselwa ukwelapha i-cholesterol ephakeme.
- Iqembu le-levothyroxine elaphashwa laliphindwe izikhathi ezingu-1 46 zokuthatha izidakamizwa zokucindezeleka.
- Iqembu le-levothyroxine elaphathwe kabi libika ukuthi liphansi kakhulu ngokomzimba kuneqembu elilawulayo.
- Iqembu le-levothyroxine elaphathwa ngokweqile libika izinsuku ezingaphezulu ngenyanga eyedlule lapho bezwa ukuthi impilo yabo engokwengqondo nengokwengqondo "ayifanele."
Theories
Abacwaningi bathi banemibono emibili yokuthi kungani-naphezu kokuba i-euthyroid ngamazinga e-TSH ebangeni lokubhekisela-iqembu le-levothyroxine lalashwa alizange liphilile njengoba lilinganiselwe ngamanani emingcele, futhi kungani i-levothyroxine ngokwabo ibike ukuthi ayizange ' T uzizwa kahle kakhulu kaningi kuneqembu elilawulayo.
- Enye inkolelo yukuthi naphezu kwezinga elijwayelekile le-TSH, amazinga ka-T3-i-hormone esebenzayo-kungenzeka ukuthi ingasetshenziswa ngokugcwele, ngoba i-T4 ayiguquli ngokwanele ibe ngu-T3.
- Ithiyori yesibili ibonisa ukuthi amazinga ka-T3 afinyelele ama-cell angase angabonakali amazinga we-TSH noma i-T4 yegazi, ngenxa yezenzo zama-deiodinases, adlala indima ekutheni inqubo yokuguqula i-T4-to-T3.
Abacwaningi baphetha iphephandaba le-athikili ngalokhu okulandelayo:
Umqondo wokuthi ukusungula i-serum evamile i-TSH kwenza abantu ku-(levothyroxine) monotherapy emtholampilo euthyroid kufanele babuyekezwe futhi izinga lezinyathelo zokuphila kufanele libekwe phambili kakhulu ekucwaningweni kwe-hypothyroidism kanye neziqondiso zomsebenzi.
Ukuqonda Okungeziwe Okuvela Kumlobi Wezifundo Antonio Bianco, MD
Omunye wabalobi abacwaningayo, u-Antonio Bianco, MD, umongameli osanda kudala we-American Thyroid Association, kanye noprofesa eRush University, wanikeza ingxoxo ku-MedicalResearch.com. Kuleyo ngxoxo, wachaza lolu cwaningo ngokuqhubekayo:
Ngokubaluleka kombuso isifundo samanje sibonisa ukuthi ukujwayelekile kwezilinganiso ze-TSH kuziguli ze-hypothyroid kungase kungabi usizo njengoba kucatshangwa ukuthi kuqapha ukwelashwa. Naphezu kwamazinga ajwayelekile e-TSH, iziguli zisezingeni eliphakeme eliphakeme lokuthuthukisa ukucindezeleka kanye nokukhubazeka komzimba okunomzimba obonakaliswa isisindo somzimba okwandisiwe namazinga aphezulu e-cholesterol ... Sathi ukuthi ngokujwayelekile ukwenza amazinga wegazi we-TSH zonke izimpawu ezihlobene ne-hypothyroidism kufanele zihambe . Lokhu kudinga ukushintsha.
Enkulumweni yokunyathelisa mayelana nokucwaninga, okukhishwe yiRush University Medical Center lapho kwenziwa ucwaningo, uDkt. Bianco naye wathi:
Nakuba umgomo wokwelapha ukwenza iziguli zizizwe zingcono, izimpawu zodwa azizisebenzisanga ukwahlulela ngokwanele ukwelashwa. Amazinga e-Blood TSH ayenjalo. Ngamanye amazwi, umthamo we-levothyroxine ulungiswa ngokusekelwe emazingeni e-TSH hhayi ukuthi ngabe isiguli sizizwa kangcono yini noma cha. Into ebalulekile ukuqonda ukuthi i-T4 akuyona i-hormone esebenzayo. I-T4 kumele iguqulwe ku-T3 ngemizimba yethu nge-enzyme ebizwa ngokuthi deiodinase.
Iziguli zikhononda ngokuthi zicindezelekile, ziphuza futhi zinezingqondo ezinengqondo. Kunzima ukulahlekelwa isisindo. Bakhononda ngokuthi banesisindo futhi banamandla angaphansi. Kodwa thina odokotela siyaqhubeka sitshela ukuthi, "Ngininika inani elifanele lemithi futhi i-TSH yakho iyinto evamile. Kufanele uzwe kahle."
Lezi zithole zihambisana nalokho okushiwo iziguli. Lezi zincwadi zokucwaninga okokuqala, ngendlela engafanele, ukuthi iziguli ze-levothyroxine zizizwa zibi nakakhulu futhi zingasebenzi kakhulu kunokulawula, zibonisa ukungavamile kwezinto ze-cardiometabolic naphezu kokuba namazinga ajwayelekile we-TSH.
UDkt. Bianco ungomunye wabaholi emkhakheni wokucwaninga ukuthi izifo ezithile ezithinta izifo kwezinye iziguli zingaphazamisa umsebenzi we-deiodinase futhi zonakalise ukuguqulwa kwe-T4-to-T3, nokuthi ngabe ukufakwa kwe-T3 kuya ku-levothyroxine monotherapy kungabangela ukulungiswa okungcono izimpawu, ikhwalithi yesineke yokuphila, kanye nemingcele yempilo eyenziwe ngabantu abathile abaphathwa nge-hypothyroidism.
UDkt. Bianco utshele obala ukuthi ukholelwa ukuthi kudingeka imithi engcono yokwelapha i-hypothyroidism. Okwamanje, uncoma ukuthi odokotela basuke emadolobheni, "kulula ukuphatha, bathathe le pilisi futhi uzoba ngcono" indlela yokwelashwa, futhi esikhundleni salokho, bathathe indlela ehlukile lapho benxusa iziguli mayelana nokwelashwa kwe-hypothyroidism. NgokukaDkt. Bianco:
Odokotela kufanele babatshele iziguli zabo, "Ngizokwenza ukuthi i-TSH yakho ibe yinto evamile, kodwa uzoba engozini enkulu yokuthola isisindo, ukubhekana nokucindezeleka nokukhathala. Kungenzeka futhi ukuthi i-cholesterol yakho iyokhuphuka." Yilokho okufanele sitshele iziguli, ngokusekelwe ekufundeni kwethu.
Okushiwo Lolu Ucwaningo Lwenzela Wena
Sekuyiminyaka engamashumi amabili, abameli abaneziguli kanye nabanye odokotela bebelokhu bethi i-levothyroxine monotherapy akufanele ibe yedwa kuphela. Nakuba isebenza kwabanye abantu abane-hypothyroidism, i-subset ephawulekayo yeziguli ayisazizwa kahle, naphezu kokwelashwa nge-levothyroxine, futhi kuthiwa i-euthyroid ngamanqanaba "ejwayelekile" we-TSH, ngokuhlolwa kwegazi.
Ukuzibophezela kukaDkt. Bianco ekucwaningeni nasekuthuthukiseni ubufakazi mayelana nesidingo esingaba khona sohlobo lwe-T4 / T3 yokwelashwa okuhlangene esigabeni samagciwane we-hypothyroid kokubili okuthembisayo nokuphawulekayo. Futhi yebo, njengoba uDkt. Bianco esho, kunesidingo esingcono sokwelapha i-hypothyroidism.
Okwamanje, kukhona okukhethwa kukho iziguli ukuthi uDkt. Bianco akasivumeli esidlangalaleni. Ungaba i-Free T3 yakho ihlolwe, futhi uma iphansi noma ingalungile, ungasebenzisa udokotela ongabe engeza isidakamizwa se-T3 - njenge-Cytomel (i-liothyronine), noma i-compound, i-prescription, i-T3 drug-release time -ukuthola ukwelashwa kwakho, noma ngubani ozobeka imithi yemvelo ekhishwe imvelo njenge-Nature-throid noma i-Armor Thyroid kuwe.
> Imithombo:
> Ingxoxo no-Antonio Bianco, MD. I-MedicalResearch.com. Okthoba, 14, 2016.
> Isikhungo sezokwelapha saseRush University. Ukukhishwa kwe-Press: Izimpawu ze-Hypothyroidism zihlale zihlala naphezu kokusetshenziswa kwemithi, ukuhlolwa kwegazi okuvamile. Okthoba 12, 2016. Science Daily.
> USarah Peterson, u-Elizabeth A. McAninch, u-Antonio C. Bianco. Ingabe i-TSH evamile efana ne-"Euthyroidism" ku-Levothyroxine Monotherapy? I Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2660