Ucwaningo Luthola Iningi Labagulayo Bazizwa Bangcono Ngokungezelela T3
Ngo-February 11, 1999 - INqabayokulinda ka-February 11, 1999 ye-New England Journal of Medicine ibika ngemiphumela yocwaningo eyathola ukuthi "ukwelashwa nge thyroxine kanye ne-triiodothyronine kwathuthukisa izinga lokuphila kwamagciwane amaningi [hypothyroid]."
Lesi sihloko sibizwa ngokuthi:
"Imiphumela ye-Thyroxine ngokuqhathaniswa ne-Thyroxine kanye ne-Triiodothyronine kuziguli ezine-Hypothyroidism"
nguRobertas Bunevicius, uGintautas Kazanavicius, uRimas Zalinkevicius, u-Arthur J Prange, uJr.
Ucwaningo lwenziwe yi-Institute of Endocrinology, i-Kaunas Medical University, iKaunas, iLithuania kanye noMnyango Wezokwelapha, Isikole Sezokwelapha, i-University of North Carolina, iChapel Hill.
Yeka ukuthi isifundo senziwa kanjani
Ngokuyinhloko, bathatha iqembu labantu abangu-33 ababese-hypothyroid, ngenxa yokugula kwesifo se-thyroid, noma ukususwa kwe-thyroids ngenxa yomdlavuza wegciwane. Zonke iziguli zafundwa ngezikhathi ezimbili zamasonto amahlanu. Phakathi nesikhathi esisodwa samaviki amahlanu, isiguli sathola umthamo wakhe ovamile we-levothyroxine yedwa. (I-Levothyroxine yigama elivamile lamagama egama njengo-Euthyrox, Levoxyl, Levothroid ne-Synthroid.) Phakathi nenye isikhathi sesonto elihlanu, isiguli sathola i-levothyroxine PLUS triiodothyronine (T3.) (Qaphela: E-US, igama legama I-T3 "i-Cytomel.") Esigabeni se-T4 kanye ne-T3, i-50 μg yesilinganiso se-levothyroxine yesiguli ishintshwe ngu-12.5 μg we-triiodothyronine (T3).
Ukuhlukahluka kwegazi, ukuqonda, imizwelo kanye nokuvivinya umzimba kwaqhutshwa ngezigaba ezahlukene zokuhlolwa.
Imiphumela
Ngokombono wezinto zomzimba, umehluko phakathi kokushaywa komzimba, ukucindezelwa kwegazi, ukucabangela kanye neminye imisebenzi ehlukahlukene ye-T4 yedwa, ngokuhambisana ne-T4 kanye ne-T3, yayincane kakhulu. Ukucindezeleka kwegazi ne-cholesterol empeleni kwehla kancane ku-T4 kanye no-T3.
Lapho imiphumela yayimangalisa khona ekusebenzeni kwengqondo. Iziguli zenziwe kangcono ezinhlobonhlobo zemisebenzi ejwayelekile ye-neuropsychological ku-T4 kanye ne-T3. Isimo sengqondo seziguli sigcizelele ngcono ku-T4 kanye no-T3.
Ekupheleni kwesifundo, iziguli zabuzwa ukuthi zikhetha yini ukwelashwa kokuqala noma kwesibili. Iziguli ezingu-20 zithi zikhetha ukwelashwa kwe-T4 kanye ne-T3, ayi-11 ayengayithandanga noma yiyiphi indlela, futhi kuphela 2 ekhetha uT4 kuphela. Iziguli ezingu-20 ezikhetha i-T4 kanye ne-T3 zibike ukuthi zinamandla amaningi, zithuthukiswa, futhi zazizwa zibe ngcono.
Abacwaningi bathi "ukwelashwa ne-thyroxine kanye ne-triiodothyronine kwathuthukisa izinga lokuphila kweziguli eziningi."
Abacwaningi baphakamisa nokuthi uhlelo oluhle lokumiswa kwe-hormone le-hormone lomuntu olungenalo i-gland yegland, noma i-gland yegciwane layo cishe lingasebenzi, kungaba "u-10 μg we-triiodothyronine nsuku zonke kufomu lokukhululwa okuqhubekayo ... kanye ne-thyroxine eyanele ukuqinisekisa i-euthyroidism. "
Imiphumela Yelashwa Yakho
Lolu cwaningo lunomthelela omkhulu kubantu abangazizwa kahle endaweni yabo yamanje ye-hormone ye-thyroid.
Uma usuhlobo lwe-levothyroxine olujwayelekile kuphela, kungenzeka ukuthi, njengeziningi zezifundo zokufunda, nawe ungase uzizwe ungcono ngokufaka umkhiqizo we-T3 wokukhipha isikhathi esimeni sokunconywa okuphakanyisiwe.
Uma ukhona kwi-Armor Thyroid noma i-Thyrolar, amaphesenti wamanje we-T3 kulezo zidakamizwa angase aphakame kakhulu, uma kuqhathaniswa nezilinganiso eziphakanyisiwe ezichazwe kulolu cwaningo. Imiphumela emihle ingatholakala ngokuguqula umuthi wokwelashwa ukuze uhambisane ngqo nenani elinconywayo elichazwe kulesi sihloko.
Uma unesifo se-hormone ye-thyroid futhi ungazizwa kahle, ngincoma ukuthi uzokwazisa udokotela wakho ngokushesha ngalolu cwaningo lokucwaninga, bese uthola ikhophi yalesi sihloko nawe.
Uma uzokwabelana nganoma yiluphi ulwazi ngudokotela wakho, ngesikhathi esifanayo, ungase ufune ukwabelana nekhophi ye- British Medical Journal esichaza ukuthi izindinganiso ezingaphezu kwe-TSH ye-2 kungenzeka ukuthi "azivamile," kodwa empeleni zimele Amazinga angavamile afakazela i-thyroid kakade ekwenzeni ukwehluleka.
Ungalayela ikhophi ngokubiza uMnyango Wezinkonzo Zamakhasimende eNew England Journal ngo-1-800-THE-NEJM
Isithombe esikhulu kunazo zonke iziguli ezithintekayo
Lokhu empeleni kuyinkimbinkimbi yokucwaninga, okuqinisekisa endaweni yokucwaninga ukuthi iziphi iziguli eziningi, mina nazo ezibandakanya, kanye nabanye odokotela, bezilokhu zithi iminyaka eminingi: i-levothyroxine-kuphela i-hormone ye-thyroid esikhundleni sayo ayishiyi ingxenye enkulu yeziguli ze-hypothyroid ezizwa kahle, futhi lezi ziguli zizwa futhi zisebenza kangcono uma i-T3 ingeziwe esikhundleni sayo se-hormone ye-thyroid.
Kuyathakazelisa ukuthi lokhu kunikeza incazelo yokuthi kungani iziguli ziye zazizwa zihlala kahle kwezinye izidakamizwa ze-thyroid ezifana ne-Armor Thyroid, Westhroid ne-Naturethroid, ene-T4 ne-T3 ngokwemvelo, kanye ne-Tro / T3 yezidakamizwa ze-Thyrolar, okuyi-drug thatha. Kwezinye izimo, iziguli zanezela i-Cytomel (yokwenziwa kwe-T3) noma i-T3-release release time to the levothyroxine therapy futhi ibe nemiphumela engcono.
Sekuyiminyaka, iziguli ziye zatshelwa ukuthi bonke abadinga ukwelashwa kwe-levothyroxine ukuze zifake "ohlwini olujwayelekile lwe-TSH," futhi ukwelashwa kwegciwane kuthathwa njengokuphelele. Isikhathi nesikhathi, abantu ababe behlushwa izimpawu - kubandakanya ukukhathala, ukucindezeleka, izinkinga zokucabanga, nokunye okuningi - bathelwa ukuthi uma uhla lwabo lwe-thyroid luvamile, lezi zinkinga zazingasondelene ne-thyroid, futhi esikhundleni salokhu bebekhona ukucindezeleka , ukucindezeleka, PMS, noma nje "ekhanda lakho." Iziguli ezazenze kahle iminyaka e-Armor, zashintsha ku-Synthroid, isibonelo, futhi zikhononda ngokuthi azizwa kahle zatshelwa ukuthi "ziguga."
Cabanga ngalesi simemezelo esanda ku- The Bridge, iphephandaba lekota elivela kwi-Thyroid Foundation of America, inhlangano okumele ibe yinkinga yezinkinga zesiguli kanye nokukhuthaza:
"Izivivinyo ze-TSH ziqondile kakhulu, futhi uma i-TSH yakho ijwayelekile, ukukhubazeka kwe-thyroid akuyona imbangela yalezi zimpawu."
UDouglas Ross, Umeluleki Wezokwelapha we-Thyroid Foundation yaseMelika
Akucaci neze ukuthi iziguli ziye zazinganakwa, zahlushwa, zazinakwa futhi zaphazamiseka uma nje zenziwe yizokwelapha zokwelapha ezijwayelekile, izinhlangano ze-thyroid namaqembu ezempilo.
Phakathi naleso sikhathi, odokotela ababeke izidakamizwa zemvelo ye-thyroid njenge-Armor - noma ngisho ne-Thyrolar engumlingani wakho wezinhlamvu - babhalwa njengezinkampani, noma abangenakuziphendulela, noma kwezinye izimo, beze bakhuliswa ngamacala yi-levothyroxine kuphela-zealots kumabhodi azokwelapha asekhaya .
Masithemba ukuthi lolu lwazi lubangela ukuthi iziguli nezinhlangano zezokwelapha, kanye nodokotela, baqale ukulalela ngaphezulu iziguli - hhayi ezinkampanini zokwelapha.
Ngokusobala, kube yindawo yokuthengisa yezinkampani ezifana ne-Knoll Pharmaceutical, i-manufactuer ye-Synthroid, ukuthi i-levothyroxine yedwa yiyo yonke into edingayo. Ukulandela ngemuva kanye nokuqeda wonke amagama kube yizinhlangano ze-endocrinologists ezithokozela ngokuzithandela kuNoboll kanye nokunikezwa kwemali yabanikazi bezimali, imali yokuxhasa iphrojekthi, izimali zenkomfa, kanye namahhala, futhi bayenqikaza ukugubha isikebhe semali ye-levothyroxine.
Ukuhamba phambili kwaba ngabalingani abafana noRichard Guttler, ozibiza ngokuthi "i-thyroidologist" futhi uphawula iziguli imali engama-dollar angu-150 noma ngaphezulu - "okudingekayo kusengaphambili" - "nge-Second Opinion" yesevisi kwi-Intanethi. Ngonyaka odlule, wagxeka ngokuthukuthela iziguli ezikhononda ngezibonakaliso ezingaphendulwanga kanye nesifiso sokuzama le mithi ehlukile manje etholakala ukusebenza kangcono. Ngonyaka odlule, umfundi we-website wabhala kuye ukuze amtshele ukuthi ukungabikho kwe-Synthroid ngemuva kwezinsuku ezintathu kuya kwezine kuphela kwamkhulula ukukhwehlela okuqhubekayo okukhwehlela okwakuyiminyaka engamashumi amabili (noma ngaphezulu) edlule. Wamtshela ukuthi ushintshile waba yizikhali. Wabhala kuye: "thola impilo! I-synthroid ayiyona imbangela yezinkinga zakho." Ngonyaka odlule, uGuttler naye wangikhathaza ngegama lakhe eliyingqayizivele "lokulala kombhede" (ukungabi namakhono okusebenza kahle kanye neziphumlisi nguye):
"Ngiyathokoza yonke" imicengezi "egcwalisa i-imeyli yakho, hhayi eyami. yenza ukuphila kwami kube lula ukubhekana neziguli ezitholakalayo kuphela ezingeke zicabange ukuthatha izikhali noma i-combo thyrolar noma i-cytomel. wenzani uma ekugcineni bathatha i-thyrolar emakethe? ngokulandelayo kuyoba umklami wemvelo umquba we-thyroid owenziwe ngokwayo kwiwebhusayithi yakho ... dr.g "
Ukuqagela zonke iziguli ezigijima ngokushesha njengoba zikwazi ukuphuma ezidinini ezinjenge-"dr g" zizosebenza ngokuya kwinani elikhulayo "lezintambo" - odokotela abanobuchule, abanolwazi abanamakhono abalalele iziguli, bazicabangela, baqhubekele phambili naphezu kontanga ukucindezela kanye nokuxhaswa kwemikhiqizo yezokwelapha, konke okuqhubekayo ngokusekelwe ngolwazi lwabo ukuthi izidakamizwa ze-T3 zisebenza kangcono kuningi lethu.
Futhi labo odokotela abaye balahlwa isikhathi eside kangaka "emifanteni" manje seboniswe ngokuvumelana nenye yezinto ezisemqoka kakhulu zemithi ejwayelekile, i- New England Journal of Medicine