Ukuxilongwa Kuncike Ngokujulile Ezivivinyweni Zegazi
Uma wena noma othandekayo enezibonakaliso noma izimpawu zesifo se-thyroid esingasebenzi (okuthiwa i-hypothyroidism), kubalulekile ukubona udokotela wakho ukuhlolwa okuphelele. Ukuze uhlole inkinga ye -roid, udokotela wakho uzokubuza imibuzo mayelana nomlando wakho wezokwelapha zomuntu siqu nomndeni, ahlolwe ngokomzimba, futhi ahlole ukuhlolwa kwegazi (ikakhulukazi, i-hormone ye-thyroid-stimulating, noma i-TSH test).
Uma udokotela wakho ekuthola nge-hypothyroidism, uzophinde afune ukwazi imbangela yokungasebenzi kwakho kwe-thyroid, njengoba lokhu kuzokwenza ukuthi uhlele uhlelo lwakho lwezokwelapha. Ukuze uveze ukuthi "kungani" ngemuva kokuxilongwa kwe-hypothyroid yakho, kungase kudingeke ukuba uhlolwe ngokuqhubekayo, njengokuhlola kwegazi lomuntu.
Thola udokotela
Abantu abaningi bathola ukuthi bane-hypothyroidism ngudokotela wabo womndeni noma e-internist. Noma kunjalo, odokotela bokunakekelwa okuyisisekelo banolwazi oluhlukahlukene ekulawuleni isifo se-thyroid.
Umsebenzi wakho wokuqala kufanele ufunde ukuthi noma ngabe udokotela wakho wokunakekelwa oyinhloko uzizwa ekhululekile yini ekunakekeleni, noma uma kufanele uthintane ne-endocrinologist (udokotela ogxile ekwelapheni izifo ze-hormone).
Ekugcineni, ungabona i-endocrinologist kanyekanye, bese udokotela wakho oyinhloko ukhathalela isifo sakho se-thyroid ukuqhubekela phambili. Ngaphandle kwalokho, i-endocrinologist yakho ingenza konke ukunakekelwa kwakho kwe-thyroid unyaka nonyaka uma kunjalo.
Ngaphansi kokuhlolwa
Uma ubona udokotela ngokokuqala ngqa ngezibonakaliso noma izimpawu ezisolisayo nge-hypothyroidism, ungalindela ukuba uthole umlando ophelele wezokwelapha nokuhlolwa komzimba.
Ngemuva kokubukeza noma yiziphi izimpawu ezintsha ezibonisa ukuthi umzimba wakho ungasondeli kahle (isibonelo, isikhumba esisheshayo, ukukhathala kalula, ukubandlululwa okubandayo, noma ukuqothulwa), udokotela wakho uzobuza imibuzo ethize ngomlando wakho wezokwelapha, njenge:
- Ingabe unezinye izifo ezizimele (isibonelo, isifo samathambo noma uhlobo lwesifo sikashukela 1?)
- Ngabe unamalungu omndeni one-hypothyroidism?
- Wake wahlinzwa ukuhlinzwa?
- Ingabe uthatha noma yimiphi imithi eyenza i-hypothyroidism njenge-amiodarone noma i-lithium?
- Uthatha noma yiziphi izithako ezine-iodine?
- Wake wafaka imisebe entanyeni yakho, ukwelapha i-lymphoma noma ikhanda lomkhanda nentamo?
Ngaphandle komlando wezokwelapha, udokotela wakho uzohlola i-thyroid yakho yokwandisa (ebizwa ngokuthi i-goiter) kanye neziqhumane (ama-nodules). Udokotela wakho uzophinde ahlole izibonakaliso ze-hypothyroidism njengengcindezi ephansi yegazi, ukugulisa okuphansi, isikhumba esomile, ukuvuvukala nokuzindla okunengqondo.
Ama-Labs nezivivinyo
Ukuxilongwa kwe-hypothyroidism kuncike kakhulu ekuhlolweni kwegazi.
I-Hormone evuselela i-Thyroid (TSH)
Isivivinyo se- TSH yisilingo esiyinhloko esisetshenziselwa ukuxilongwa nokuphathwa kwe- hypothyroidism . Kodwa ama-labs ahlukene ngokuvamile anezindinganiso ezihlukile okwakwaziwa ngokuthi "uhla lwe-reference lwe-TSH."
Kulabhu amaningi, ububanzi bezinkomba ze - TSH bugijima kusuka ku-0.5 kuya ku-4.5. Inani le-TSH elingaphansi kwe-0.5 libhekwa njenge- hyperthyroid, kanti inani le- TSH elingaphezu kuka-4.5 libhekwa njengelingaba yi- hypothyroid.
Amalabhu ahlukene angasebenzisa umkhawulo ophansi we-0.35 kuya ku-0.6, nomgqa ongaphezulu we-4.0 kuya ku-6.0.
Kunoma yikuphi, kubalulekile ukuba uqaphele ibanga lokubhekisela kulobhu lapho igazi lakho lithunyelwa khona, ngakho wazi izindinganiso ozitholwa ngazo
Uma ukuhlolwa kwe-TSH kokuqala kwegazi kuphakanyisiwe, kuvame ukuphindaphindiwe, futhi ukuhlolwa kwe-thyroxine T4 yamahhala nakho kudonseleka.
I-Thyroxine yamahhala (T4)
Uma i-TSH iphezulu futhi i-T4 yamahhala iphansi, ukuxilongwa kwe- primary hypothyroidism kwenziwa.
Uma i-TSH iphakeme, kodwa i-T4 yamahhala iyinto evamile, ukuxilongwa kwe- subclinical hypothyroidism kwenziwa. Ukwelashwa kwe-subclinical hypothyroidism kuncike ezintweni eziningi.
Isibonelo, udokotela wakho angaphatha i-subclinical hypothyroidism uma unempawu ezifana nokukhathala, ukuqothulwa, noma ukucindezeleka, noma unezinye izifo ezizimele, isibonelo, isifo se-celiac.
Ubudala, futhi, buzobamba iqhaza kwisinqumo sikadokotela wakho. Ngokuvamile, kunomkhawulo ophakeme wokuqala imithi ye-hormone esikhundleni somuntu abadala; lokhu kungenxa yokuthi i-TSH yabo yokuqala isemkhawulweni ophezulu wokujwayelekile.
Ukutholakala kwamagciwane okulwa ne-TPO (bheka ngezansi) futhi kudlala indima kwisinqumo sakho. Uma une-subclinical hypothyroidism nama-antibodies ama-TPO enhle, udokotela wakho cishe uzoqala ukwelashwa kwe-hormone ye-thyroid, ukuze avimbele ukuqhubeka kwe-subclinical hypothyroidism ibe ngaphezu kwe-hypothyroidism.
Ukuxilongwa okungavamile kwe- central or secondary hypothyroidism kuyinto encane kakhulu. I-hypothyroidism ephakathi iphakamisa inkinga ye-pituitary noma i-hypothalamus. Lezi zakhiwo zobuchopho zilawula igciwane le-thyroid futhi zingalimala ezikhunjini, izifo, izifo zemisebe, nezifo ezinjenge-sarcoidosis, phakathi kwezinye izimbangela.
Ephakathi kwe-hypothyroidism, i-TSH iphansi noma evamile futhi i-T4 yamahhala ngokuvamile iphansi kancane noma iphansi.
I-TPO Antibodies
Amaphilisi omzimba we-peroxidase (TPO) enhle aphakamisa ukuxilongwa kwe-Hashimoto's thyroiditis, okuyiyona imbangela evame kakhulu ye-hypothyroidism e-United States. Lezi zinselo zamabhomu zihlasela kancane igulane le-thyroid, ngakho-ke ukuthuthukiswa kwe-hypothyroidism kuvame ukuba yinkambinkimbi, njengoba i-thyroid iba yilapho engakwazi ukukhiqiza i-hormone yegciwane.
Lokhu kusho ukuthi umuntu angaba "nama-antibodies" ama-TPO, kodwa umsebenzi ovamile we-thyroid isikhathi esithile; Eqinisweni, kungathatha iminyaka umsebenzi womuntu we-thyroid ukuthi wehle kuze kube seqophelweni lokuba i-hypothyroid. Abanye abantu baze babe nama-antibodies ama-TPO amahle futhi bangalokothi bathuthuke ekubeni yi-hypothyroid.
Ngenkathi udokotela wakho engeke akwazi ukuphatha imithi ye-hormone esikhundleni somuthi uma ama-antibodies akho e-TPO enza kahle kepha iTSH yakho ingaphakathi kwebala lokubhekisela ejwayelekile, cishe uzoqapha i-TSH yakho ngokuhamba kwesikhathi.
Ukucabanga
Nakuba ukuhlolwa kwegazi kuyisimo esiyinhloko sokuhlola i-hypothyroidism, udokotela wakho angalalela i-ultrasound ye-thyroid uma ephawula (noma efuna ukumhlola) i-goiter noma i-nodules ekuhloleni kwakho ngokomzimba. I-ultrasound ingasiza udokotela ukuba anqume ubukhulu be-nodule nokuthi ngabe unezici ezisolisayo ngomdlavuza. Ngezinye izikhathi, i-biopsy yenaliti (ebizwa ngokuthi i-asple enhle, noma i-FNA) eyenziwa ukuthola isampula yamaseli ngaphakathi kwesikhomba. Lawa maseli angabuye ahlolwe ngokucophelela ngaphansi kwe-microscope.
Endabeni ye-central hypothyroidism, ukucabangela kwenziwa ukuhlola ubuchopho kanye ne-pituitary gland. Ngokwesibonelo, i- MRI ye-pituitary gland ingabonisa isisu, njenge-adenoma ye-pituitary.
Ukuhlonza okuhlukile
Izimpawu ze-hypothyroidism ziyahlukahluka kakhulu futhi zingase zingabanjwanga kalula noma ziphuthelwe ngesinye isimo sezokwelapha.
Ukuthola Okunye Okusekelwe Ezibonisweni
Kuye ngezibonakaliso zakho eziyingqayizivele, udokotela wakho uzokuhlola ngezimo ezithile zokwelashwa (ikakhulukazi uma i-TSH yakho ijwayelekile). Lokhu kungafaka:
- I-anemia
- Ukutheleleka ngegciwane (isibonelo, i-mononucleosis noma isifo se-Lyme)
- Ukuntuleka kwe-Vitamin D
- I-Fibromyalgia
- Ukucindezeleka noma ukukhathazeka
- I-apnea yokulala
- Isifo noma isifo sezinso
- Esinye isifo se-autoimmune (isibonelo isifo se-celiac noma i-rheumatoid arthritis)
Ukutholakala Kwezinye izindlela Ngokusekelwe Imiphumela Yokuhlolwa Kwegazi
Ngenkathi i-hypothyroidism eyinhloko ingase ibe yingozi kakhulu ngemuva kwe-TSH ephakanyisiwe, kukhona okunye okuthola ukuthi udokotela wakho uzozikhumbula. Ngokwesibonelo, ukuhlolwa kwegazi le-thyroid okweseka ukuxilongwa kwe-central hypothyroidism kungase kube yilapho kungabonakali okwe-nonthyroidal.
Ukungaboni kahle
Abantu abafakwe esibhedlela abanesifo esibucayi noma abaye bathola ukufakelwa komnkantsha wamathambo, ukuhlinzeka okukhulu, noma ukuhlasela kwenhliziyo kungase kube nokuhlolwa kwegazi okwenziwa nge -roid okuhambisana ne-central hypothyroidism (i-TSH ephansi ne-T4 ephansi) -kuthi, "ukugula okungenayo i-nonhyroidal" hhayi ngokuvamile ukwelashwa kwemvume.
Kulesi sibonelo, ukulinganisa ukuhlolwa kwegazi okubizwa ngokuthi i-reverse T3, i-metabolite ye-T4, kungasiza ekuhlukaniseni phakathi kweqiniso eliphakathi kwe-hypothyroidism nokugula okungenayo i-nonthyroidal. I-T3 eguquguqukayo iphakanyisiwe ekuguleni okungenayo i-nonthyroidal.
Ekuguleni okungenayo i-nonthyroidal, ukuhlolwa kwegazi okwenziwa nge-thyroid kufanele kuvamile uma umuntu ehlulwa ekuguleni kwakhe. Nakuba, abanye abantu bahlakulela i-TSH ephakeme ngemva kokululama. Kulaba bantu, ukuphinda i-TSH emavikini amane kuya kwesikhombisa kuvame ukuveza i-TSH evamile.
Ukungaqiniseki Kwamazinga Okungavumelani
I-Hypothyroidism ne-adrenal insufficiency ingase ihlangane, njengoba isebenza esimweni esingavamile okuthiwa i-autoimmune polyglandular syndrome. Le syndrome ibangelwa izinqubo ezizenzakalelayo ezibandakanya izigulane eziningi, ikakhulukazi isifo se-thyroid (esibangela i-hypothyroidism) kanye nezigulane eziyingozi (okubangelwa ukungasebenzi kahle).
Esinye sezingozi ezinkulu ezihlobene nalesi sifo siphatha i-hypothyroidism (ukunikeza i-hormone substitution esikhundleni) ngaphambi kokwelapha u-hypoadrenalism (okudinga ukwelashwa kwe-corticosteroid), njengoba lokhu kungabangela inkinga yokuphila engozini. Ngeshwa ngaleli syndrome, ukungazenzisi kungase kungabanjwanga ngenxa ye-TSH ephakeme nezimpawu ezingacacile ezihambisana nalabo abonakala ku-hypothyroidism.
I-TSH-ikhiqiza i-Pituitary Adenoma
Uma i-TSH iphakanyisiwe, kubalulekile ukuthi i-T4 yamahhala ihlolwe futhi. Ku-hypothyroidism eyinhloko, i-T4 yamahhala kumele iphansi, kepha uma umuntu ene-TSH-secreting pituitary tumor, i-T4 yamahhala iyophakanyiswa.
> Imithombo:
> I-American Thyroid Association. (2013). Incwajana Yeziguli Nemindeni Yabo .
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. I-WLL / Wolters Kluwer; 2012.
> Garber J et al. Imihlahlandlela Yokuzivocavoca Yomtholampilo ye-Hypothyroidism Kubantu Abadala: I-Cosponsored yi-American Association of Clinical Endocrinologists kanye ne-American Thyroid Association. I-Endocrine Practice . 2012 Nov-Dec; 18 (6): 988-1028.
> Gaitonde DY, Rowley KD, Sweeney LB. I-Hypothyroidism: isibuyekezo. Am Fam Physician. 2012 Aug 1; 86 (3): 244-51.
> Upala S, Yong WC, i-Sanguanke A. Ukungasebenzi kahle okuyinhloko okungaziwa ngokuthi i-hypothyroidism egulini le-polyglandular syndrome. N Am J Med Sci . 2016 Meyi; 8 (5): 226-28.