Umhleli kusuka kuMary Shomon
Enye yezindaba eziphikisana kakhulu ezibhekene neziguli ze -roid e-US nasemhlabeni wonke ukuthi iziguli kufanele zizisebenzise ngokwabo ukuphatha izinkinga ze-thyroid, ikakhulukazi i-thyroid / hypothyroidism engasebenzi. Uma ngithi "ukuziphilisa," ngisho ukuthenga imithi ye-hormone ye-hormone esikhundleni somuthi ngaphandle kwesidakamizwa kadokotela, bese uthatha leyo mithi ngaphandle kokubheka udokotela.
(Angibheki kulawo magciwane odokotela abanikeza imithi ye-thyroid kodwa bese bavumela iziguli ukuba zikhuphuke noma zihambe ngaphansi kwesilinganiso phakathi kokuvakashelwa.)
Ukuzivocavoca kwe-hypothyroidism ngokusobala kunezinselele ezibonakalayo ezibhekene neziguli.
Okokuqala, uma umuntu engakaze atholakale njenge-hypothyroid, kodwa kunalokho, ukuzivikela kwakhe, khona-ke esinye isimo singase singaphuthelwa - futhi singaphenduliwe. Izimpawu ezinjengokukhathala, ukunyuka kwesisindo, nokucindezeleka kuvamile ku-hypothyroidism, kodwa nazo izimpawu zezinye izimo eziningi - okunye okungathí sina. Ukwehluleka ukuthola ukuxilongwa okufanele nokwelashwa kungabe kube yingozi kumguli owenza iphutha ukuzihlola nokuzibulala ngemithi okuthiwa i-hypothyroidism.
Okwesibili, umsebenzi we -roid awuhlali njalo. Abantu bangaba nezinkathi zesikhashana ze-hypothyroidism ngenxa yemithi, i-thyroiditis, noma i-postpartum nezindaba ze-thyroid emva kokuzalwa komntwana, kulandela ukubuyela emsebenzini ovamile we -roid.
Izinga elifanele lokwelashwa lingasheshe liqedwe lapho i-thyroid iguquka.
Okwesithathu, kukhona ingozi yokuzibophezela. Ukwehlukaniswa okungekho emthethweni kwandisa ingozi kwezinye izimo eziningi kuhlanganise nesifo senhliziyo, ukukhuluphala, nokucindezeleka. (Yiqiniso, ukungatholi ukwelashwa nhlobo ngenxa ye-hypothyroidism nakho kuyingozi enkulu nakakhulu yalezi zinkinga zempilo.)
Kodwa okwesine nokukhathazeka okukhulu kwabaningi kungengozi ukuthi labo abazitholela imithi bayodliwa ngokweqile . Ukuthatha imithi eminingi yokwelapha i-hormone ingabangela izimpawu ezihlukahlukene, kuhlanganise nokukhathazeka, ukuhlaselwa kwesibindi, ukuthuthumela, isifo sohudo esingapheli, ukucindezeleka kwegazi, i-tachycardia (ukushaya kwenhliziyo okusheshayo), ukushaya kwenhliziyo, ukushaya kwenhliziyo, kanye nokungahambi kahle kwenhliziyo eyaziwayo njenge -fibrillation ye-atrial . I-fibrillation ye-atrial - ngezinye izikhathi ebizwa ngokuthi "i-a-fib," ingabangela ukulimala, okungase kube nomphumela wokukhubazeka okungapheli ngisho nokufa.
Ezinye iziguli ziphakamisa ukuthi ukuzivocavoca kuphephile uma nje iziguli zinolwazi. Ngiyazi iziguli eziningana eziye zaphatha ngokuphumelelayo. Ngesikhathi esifanayo, ngibuye ngivela ezigulini eziningi ze-thyroid eziphelile emakamelweni eziphuthumayo ezibhekene ne-fibrillation ye-atrial ngemuva kwesikhathi sokuzivocavoca. Eziningi zalezi ziguli zazifunde kahle futhi zifundwe kahle ngesifo segciwane, futhi zibhekwa njengezikwazi kakhulu ngokuziphathisa izifo zazo ze-hypothyroidism. Noma kunjalo, baqeda ukudlala futhi bahlangabezana nezinkinga ezinkulu zempilo.
Nakuba iziguli eziningi - ngisho nalabo abazizwa bezethemba ngolwazi lwabo - bayazi ukuthi kunengozi yokuzibulala, lo mkhuba uqhubeka ngoba iziguli zibhekene nezingqinamba ezinkulu ezibavimbela ukuba bathole ukutholakala nokuthola ukwelashwa kwegciwane ngendlela efanele. .
Ziyini lezi zithiyo?
Okokuqala, kunabantu abaye bathola ukuthi bane-hypothyroidism esikhathini esidlule, kodwa ngubani ongakwazi ukukhokhela ukuvakashelwa odokotela. E-US kuphela, sinamamiliyoni amaningi angaqinisekisiwe, izigidi zabantu asebekhulile emali engenayo, kanye nezigidi zabantu baseMelika abaye balahlekelwa yimisebenzi ngesikhathi sokuncipha kwezomnotho. Abantu abaningi abakwazi ukukhokhela odakeni. Emhlabeni wonke, ukutholakala kodokotela abahloniphekile nokunakekelwa kwezokwelapha kuyinhlanhla ye-draw, futhi kuncike ekutheni i-geography, umnotho, uhlelo lokunakekelwa kwempilo olukhona, nesimo sezimali somuntu siqu.
Okwesibili, odokotela abaningi bahlala bedidekile ngokuthi bangayichaza kanjani ukuhlolwa kwesifo se-hormone (TSH) ye-thyroid ebizwa ngokuthi yi-"standard standard" yokuhlola i-hypothyroidism.
Uma isiguli sinemibonakalo ye-hypothyroidism, futhi sinomphumela wokuhlolwa owela endaweni ye-"limbo" yokuhlolwa kwe-TSH - ngenhla kwe-2.5 nangaphansi kwe-4.0 kuya ku-5-5.5 - imiphumela ye-TSH yesiguli ibhalwe ngamabhiya ase-US njenge "evamile" ku- umbiko webhu. I-TSH kulelo hlu ibhekwa njenge-subclinically hypothyroid ngabanye ochwepheshe, noma kunjalo. I-endocrinologists bebelokhu belwa futhi bephikisana nale nkinga cishe iminyaka eyishumi, kusukela lapho i-American Association of Clinical Endocrinologists (AACE) inconywe ekuqaleni kuka-2003 ukuthi uhla olujwayelekile lwesithenjwa sokuhlolwa kwe-TSH lungafinyelelwa ku-0.3 kuya ku-3.0 . Odokotela abaningi, namanje, balandela i-cutoff iphuzu elidala, futhi bayothola kuphela ukuxilonga nokuphatha i-hypothyroidism uma isiguli sinesifo se-TSH esiphezulu kune-4.5 kuya ku-6.0.
Okwesithathu, kuneziguli ezinezimpawu ze-hypothyroidism, futhi ngubani okuthiwa "evamile" imiphumela ekuhlolweni kwe-TSH- ewela noma yikuphi phakathi kuka -3 kuya ku-6.0 - kodwa ngubani ophakamise amakhemikhali e-thyroid aveza isifo sikaHashimoto sokuzimela. Odokotela abaningi abaqapheli - noma abazenzi ngokusho - ucwaningo olubonisa ukuthi kwezinye iziguli eziphikisana no-antibody, ukwelashwa kwegciwane kunganciphisa izimpawu ze-hypothyroid futhi kuvimbele ukuqhubekela phambili kwe-hypothyroidism.
Okwesine, zikhona iziguli ezine-TSH "evamile", kodwa amazinga ajikelezayo wehomoni ye-thyroid - i-Free T4 ne-Free T3 - abonisa ukuhluleka okucacile kula ma hormone. Odokotela abaningi benqabe ukubona ukuthi ukungabi namandla noma amazinga aphansi ajwayelekile we-Free T4 kanye / noma i-Free T3 - kanye namazinga aphakeme we-Reverse T3 noma ama-ratos angalungile we-Reverse T3 / Free T3 - abonisa ukuthi i-hypothyroidism. I-T4 iguqulwa ibe yi-T3 - i-hormone ye-thyroid esebenzayo ezingeni leselula. Kodwa odokotela abaningi bacabanga ukuthi wonke umuntu angaguqulela i-T4 kuya ku-T3 kahle futhi ngokulinganayo. Phakathi naleso sikhathi, odokotela abahlanganisayo kanye namanye ama-endocrinologists omusha, bayavuma ukuthi ezinye iziguli zingase zibe nama-antibodies, ukuphelelwa amandla kwe-enzyme, ukwehluleka kokudla okunomsoco, noma ukukhubazeka okungokwenyama okuphazamisa ukuguquguquka kwe-T4 kuya ku-T3, nokuthi lokhu kuphazamiseka kungase kuqinisekiswe ukwelashwa.
Owesishiyagalolunye, iziguli eziningi ziphathwa nge-levothyroxine izidakamizwa - okungukuthi, i-Synthroid, i-Levoxyl, i-Levothroid, i-Eltroxin, noma i-levothyroxine / l-thyroxine, kodwa isinezimpawu ezicacile ze-hypothyroidism, ngisho nangemva kokuba ukwelashwa kuye kwabuyisela imiphumela yezivivinyo zegazi legciwane " evamile. " Ezinye zalezi ziguli zicela ukwengeza imithi ye-T3 - ie, iCytomel (i-liothyronine), noma i-T3 ekhishwe isikhathi-noma icela imithi yemithi yemvelo ekhonjisiwe - okungukuthi, i-Armor, Nature-Throid, noma i-Erfa. Ukusetshenziswa kwe-T3 kuyinkinga, kodwa , odokotela abaningi abakholelwa ekusebenziseni izidakamizwa ze-T3 noma imithi yemvelo yengqondo. Laba odokotela bavame ukusho ukuthi akudingeki imithi yokwelashwa eyengeziwe ngoba izimpawu azizona ezihlobene ne-thyroid, noma ukuthi izimpawu ziyizinkinga zenkinga yempilo yengqondo futhi ziqinisekisa ukwelashwa okucindezela ukucindezeleka. Ngokuvamile, sizwa "akekho odinga i-T3 noma i-thyroid yemvelo" ngoba "wonke umuntu uguqula i-T4 kuya ku-T3 ngokuphelele." Lokhu "awudingi / wonke umuntu oguqula i-T4 kuya ku-T3" i-mantra iyi-myt ethandwa futhi ehlala njalo
h in ukwelapha hypothyroidism. Abanye odokotela benqaba ukubeka i-T3 kanye / noma izidakamizwa zemvelo yemvelo ngenxa yokuthi zizwa sengathi lezi mithi zibeka ingozi yemiphumela emibi yomuntu wonke. Kodwa izingozi ayitholakali uma imithi isetshenziswa kahle futhi inqunyiwe. Kwezinye iziguli ezinempilo, ingozi ye-T3 kanye nezidakamizwa zemvelo yemvelo kungukuthi isiguli sigxile kakhulu. Kodwa-ke odokotela bayakuqapha kodwa abanesiguli asebekhulile kanye neziguli ezinezimo zenhliziyo ezikhona ngaphambili / isifo senhliziyo, njengoba lezi zingxenye zingase zizwele ngokukhethekile ku-T3 noma imithi yokwelapha yemvelo equkethe i-T3. (Kuyathakazelisa ukuthi kukhona nophenyo olubonisa ukuthi i- hypothyroidism engaphenduliwe yandisa ingozi yesifo senhliziyo .)
Okwesithupha, kuneziguli ezithile ezihlanganiswa nezinhlangano zokunakekelwa kwezempilo (i-HMOs) noma umshuwalense wezokwelapha, odokotela babo benqaba ukuhlola ngisho ne-hypothyroidism, benqabe ukuphatha i-borderline / subclinical hypothyroidism, benqaba ukwelapha isifo se-Hashimoto, bafuni ukuhlola noma ukuphatha i-Free T4 / Ukungalingani kwe-T3 / ukungalungi, kanye / noma ukwenqaba ukunikeza imithi ye-T3 kanye / noma izidakamizwa zemvelo ye-thyroid. Ezinye iziguli ezibona lezi zodokotela zingakwazi ukukhokhela imali ehokheni ukuze zivakashele udokotela obizwa nge-thyroid-savvy.
Okokugcina, ngaphandle kwe-US, ukuzivocavoca kuba yisidingo kwezinye iziguli. E-United Kingdom, isibonelo, iningi labantu basekhaya basebenzisa iNational Health Service (NHS) ekunakekelweni kwabo kwezokwelapha. Kodwa odokotela be-NHS badinga ukuthi balandele kanzima -ngathi bangasethi, isikhathi esidlule futhi ezimweni eziningi ezingalungile - zokuhlola nokuphatha i-hypothyroidism. Ngesikhathi esifanayo, kunezinyanga ezimbalwa odokotela abazimele ukuze baxilonge kahle futhi baphathe i-hypothyroidism, futhi labo odokotela bavame ukubiza kakhulu.
Inselele yeziguli ze-thyroid
Ngakho, ekugcineni, kufanele yini iziguli zizenzele imishanguzo, noma cha? Ngisanda kubangele ukukhathazeka phakathi kweziguli ezenza imishanguzo ngoba ngitshele ukuthi angikugqugquzeli ukuzithiba, nokuthi i-Save Natural Thyroid Coalition - iqembu engasungula ehlobo lika-2009 ukusiza iziguli ukuba zibhekane nokuntuleka, ukungabi khona Ukuhlaselwa kwe-FDA emithini yemithi ekhishwe emvelo - futhi ayikugqugquzeli ukuzitholela.
Akukho mbuzo ukuthi iziguli zisesimweni esinzima. Futhi kunengqondo ephelele kimi ukuthi ezinye iziguli zinomuzwa wokuthi azikho enye indlela ngaphandle kokuzibulala. Angiyikugxeka isinqumo somuntu siqu sokuzibulala-lokho into umuntu ngamunye okumelwe azenzele yona. Kuyabuhlungu ukuthi abanye abantu baphoqeleka ukuba benze lokho, futhi ngithukuthele ukuthi abanye odokotela babheka kanjani isifo se-cavalierly, isimo sengqondo esenza ezinye iziguli zikhethe lokho. Ngiphinde ngithembele ngokuqinile ukuthi labo abazenza imithi bayakwenza ngokuqapha okukhulu futhi bakwazi ukugwema noma yiziphi izinkinga.
Isimo sengxabano sezinye iziguli inkolelo yami yokuthi ukugqugquzela ukuzitholela imithi ngokuzikhandla - futhi ikakhulukazi, ukugqugquzela ukuzitholela imithi nge-nature yemvelo ekhethiwe - ekugcineni kungasebenza ngokumelene nezithakazelo zesiguli se-thyroid.
Sesivele sibhekene nezikhathi ezibuhlungu zemithi ye-thyroid yemvelo engekho emkhakheni noma impela emakethe , ukungabi khona kwempahla okungaqondakali okungaqondakali, nokuthuthuka okungaqondakali okubonakala sengathi kuqhutshwa yizenzo ze-FDA ngemuva. Izidakamizwa zemvelo ye-thyroid nazo zikhona ohlwini olude lwe-FDA lwezidakamizwa "ezingavunyelwe" ekugcineni eziphoqelelwe ukuba zihambe ngezinqubo zokugunyazwa okwesikhashana nezindleko. I-FDA ikwenze kucacile ukuthi i-thyroid yemvelo yisidakamizwa esingavunyelwe, futhi ayizalwanga, futhi ekugcineni kufanele idlule ngenqubo yokugunyaza ukuze ihlale emakethe. Nini futhi kanjani lokho kuzokwenzeka kusenqunywa. Inqubo yokwenza izinqumo ze-FDA yezimvume ezingavunyelwe izidakamizwa ayikho into ecacile. Lokho esikwaziyo ukuthi amandla ezombangazwe nezomnotho ezenzakalweni - amabutho angenandaba nokuhlala enhlalakahle - njalo aqhuba inqubo yokwenza izinqumo.
Abanye odokotela, kanye neziphathimandla ze-FDA bangitshele ukuthi, ngaphandle kwerekhodi, ukuthi banomuzwa wokuthi ukungabi namemezelo embi - kuhlanganise namaphephandaba wezokwelapha - mayelana nokuzivocavoca kwe-thyroid kuye kwasusa izidakamizwa zemvelo ye-thyroid ukuthi zingene ekukhanyeni okungadingeki - futhi kuye kwaphumela kubo ekuhlolisweni okukhulu yi-FDA.
Esinye isithiyo emithini yemvelo yemvelo yiDkt. Sidney Wolfe weZakhamuzi Zomphakathi, owaqokwa kwi-FDA's Drug Safety and Advisory Committee Committee. Ngesizathu esithile esingaqondakali, udidekile uDkt. Wolfe - ngezinye izikhathi usho ngokucacile ukuthi i-thyroid yemvelo iyinhlanganisela engaphezu kwe-counter (akunjalo), nokuthi yenziwa kusuka ezinkomeni (yi-porcine, ezivela ezingulube) - - umphikisi ononya we-thyroid (noma okungenani noma ngabe yini okwamanje ukholelwa ukuthi i-thyroid ekhethiwe). Wanyathelisa i-diatribes egcwele izimpikiswano ngokulwa nezikhali ze-Army Thyroid ku-Newsletters "Embi Pills, Best Pills" ngaphambi kokuba afakwe bakhonze ekomidini le-FDA. Manje usesimweni sokunquma ukuthi yiziphi izidakamizwa eziphelela emikhankasini ye-FDA's Unprovedved Drugs campaign.
Futhi isithiyo esiyinhloko sihlala sisungulwe "-" futhi lapha ngizofaka phakathi i-endocrinologists, odokotela abavamile, izinkampani zezokwelapha ze-thyroid, i-FDA, ezinye izomthetho, kanye nezinkampani ezidakamizwa ezinkulu ezenza i-levothyroxine - abajabule kakhulu ukumbamba ku-ANY nakuzo zonke izikhangiso ezimbi, imiphumela emibi, noma izinkinga ezibonwayo nge-thyroid kanye / noma nge-T3 yokwelashwa, enethemba lokusebenzisa izindaba ezimbi njengendlela yokuthola lezi zidakamizwa zisuswe emakethe. Ngokudabukisayo, kodwa akumangalisi ukuthi "ukukhathazeka" kaningi akuhlangene nesezinhlalakahle zesineke nakho konke okuphathelene nokuzikhathalela, ukuzuza kwezezimali, i-groupthink ye-thyroid noma imininingwane engafanele.
Isithunywa sami se-Thyroid Advocacy Mission: Ukusebenza Ukunqoba I-Groupthinkink Ye-Thyroid
Njengommeli wesiguli, ngifuna ukugxila emizamweni yami ekusizeni ekufundiseni nasekuphakamiseni, nokukhuthaza izinguquko ohlelweni ngokwayo. Ekugcineni, ngingathanda ukuba siphile ezweni lapho iziguli ezincane ze-thyroid ziphoqelelwa ukuthi zenze ukhetho olunzima phakathi kokuzivocavoca- nezingozi kanye nezinzuzo ezihambisanayo - futhi ngaphandle kokuphathwa.
Ungenzi iphutha, lokhu kuyinjongo enzima. Ukulwa nezwe eliyinkimbinkimbi ye-endocrinology, kanye "nebhizinisi" lemithi ye-thyroid - nokuthi yiziphi odokotela abaningi abaye babhekisela kuzo ngokuthi "ukuhlukunyezwa kwe-TSH" - kunzima. Kuyinto impi abaningi bethu bebelokhu balwa iminyaka engaphezu kweyishumi. Sibone ukuthuthukiswa okunye, nokunye ukuphazamiseka endleleni.
Njengoba siyazi, kusukela embonweni wezokwelapha / wezesayensi, izinhlangano eziningi ze-endocrinology nezinhlangano ze-endocrinology ziyashesha ukwamukela izinguquko, futhi, ngokudabukisayo, zivame ukubonakala zinesithakazelo eziningana kumbiko welebhu kunokuba isiguli sihlezi phambi kwabo nokuthi ngabe leso siguli siyajabula noma yiliphi izinga lokuphila. Odokotela bathembele ekuhlolweni kwe-TSH - ukuhlolwa kwesibili kwe-hormone ye-pituitary - ukuxilonga nokuphatha i-hypothyroidism, kuyilapho uzizwa unecala lokungazinaki ngokuphelele amazinga e-Free T3 - i-hormone esebenzayo empeleni engena emangqamuzaneni ukuhambisa i-oxygen namandla. Odokotela abaningi abahlukumezi ngisho nokuvivinya ama-antibodies we-thyroid - okungasitshela ukuthi isifo se-thyroid siphelele ngokuzenzakalelayo.
Phakathi naleso sikhathi, izizukulwane eziningana ze-endocrinologists kanye nodokotela ziye zatshelwa ukuthi zokwenziwa kwe-thyroxine (T4) - eyaziwa ngokuthi i-levothyroxine / l-thyroxine - noma ngokuvamile, igama elithi Synthroid - yisisombululo esisodwa. Batshelwa ukuthi i-levothyroxine yedwa iphakeme kunokwelapha okuhlanganiswa nge-synthetic triiodothyronine (T3) - eyaziwa nge-liothyronine (i-Cytomel). Batshelwa ukuthi i-thyroid eyimvelo - okwakuyiminyaka engama-50 kuphela ukwelashwa kwe-hypothyroidism - "yinto endala," "engaqiniseki," futhi ingaphansi kwe-thyroxine yokwenziwa. Isayensi yangempela yonke indawo, noma kunjalo, nanoma yikuphi ukulandelwa kwemithi yokwelapha odokotela - kungakhathaliseki ukuthi i-levothyroxine monotherapy, ukwelapha okuhlanganiswa kwe-T4 / T3, noma ukusetshenziswa kwetrosi yemvelo ekhona - kunezifundo ezingaphakamisa isikhundla sabo esikhethiwe. Futhi uma udokotela ebhekene nesifundo esivumelana nombono wakhe noma umbono wakhe, uzovame ukuwazwa athi, "kahle, kuyisifundo 'esibi'."
Ngaphandle kwempikiswano yezokwelapha / yesayensi, imboni yezokwelapha idola inomthelela omuhle emqondweni wezisebenzi ze-thyroid.
Akuyona imfihlo ukuthi izinhlangano zezokwelapha ze-thyroid eziyisihluthulelo - okungukuthi, i-American Thyroid Association, kanye ne-American Association of Clinical Endocrinologists - zithole amakhulu ezinkulungwane zamaRandi ngonyaka ngonyaka ngezibonelelo, ukuxhaswa, ukusekelwa kanye nokuxhaswa komcimbi kwabenzi be-Synthroid. Futhi odokotela abaningi abanezindima zobuholi kulezi zinhlangano nabo bathola izimali ezivela kumkhiqizi we-Synthroid.
I-Synthroid brand ye-levothyroxine ibe yisidakamizwa esithengisa kakhulu e-US amashumi eminyaka, futhi inenzuzo kakhulu. Ezikoleni zezokwelapha, emahhovisi e-endocrinologist, nasemabhedlela abasebenza esibhedlela ezweni lonke, amathrekhi asekuseni kanye namabhayisikithi e-muffin afika njalo, akhokhelwa ngumenzi we-Synthroid, njengendlela yokusiza ukuqinisekisa ukuthi umbono wabo wezokwelapha - owodwa awufaki i-T3 futhi i-thyroid yemvelo - yilo odokotela, abahlengikazi, abasebenzi basehhovisi, abafundi bezokwelapha kanye nodokotela abasha abazwayo. Futhi ungakhohlwa imigomo yokumaketha - kanye nezidakamizwa zamahhala zamahhala kanye nama-swag afana namapeni, ama-mugs, izincwadi, amaphilisi kadokotela, ama-plastic model we-thyroids nezinye izinto - ukuthi izidakamizwa ziphinde zithunyelwe izinkulungwane ngesonto kumahhovisi odokotela , futhi unikeze njalo emhlanganweni wezokwelapha we-thyroid.
Umphumela wokuphela: sinamazukulwane amaningana odokotela abahamba ngezinyathelo zokukhiya, bekholelwa - futhi baqhubeka bezwa umlayezo lapho behamba khona-ukuthi i-Synthroid yisisombululo esisodwa sokuphela komuntu nanoma ubani onama-hypothyroidism, wonke umuntu oguqula i-T4 kuya ku-T3 ngokuphelele, ukuthi akekho odinga i-T3, nokuthi ayikho indima yemvelo yokwelashwa ekhishwe yi-hypothyroidism.
I-groupthink ye-thyroid kanye nokwehluleka kwamanye odokotela kuya emathonyeni wezezimali ezivame kakhulu kangangokuthi kunezinye ze-endocrinologists kanye nodokotela abalahla obala futhi badonsa odokotela abakanye nabo ababeka izidakamizwa ze-T3 noma imithi yemvelo yengane yeziguli.
Ukwenza noma yini engikwaziyo ukusiza ukuqeda lolu hlobo lokucabanga okuqinile - ukucabanga ukuthi kulahla abantu abaningi kangaka empilweni yokugula - kuyinto ebalulekile ekuphakamiseni kwami.
Injongo yami ukukhuthaza ukuqaphela ngokugcwele okukhethwa kukho ukwelashwa okungahle kubekwe ngokomthetho - kubandakanya i-T3 nemithi yemvelo yemvelo. Umgomo wami ukusebenzela izwe lapho uhla olugcwele lwezinketho zokwelapha eziphathelene ne-thyroid luzoqondwa kangcono, olwaziwa kangcono, olwamukelwa kangcono, oluthengekayo, futhi olutholakala ngokomthetho ... izwe lapho kunokuqonda okungcono phakathi odokotela, abathintekayo, ama-pharmacy, imiphakathi yezokwelapha, kanye neziguli zohlu olugcwele lwezinketho zokwelashwa ezifanele zempilo yakho. Futhi ngokungeziwe, umgomo wami futhi ukusiza ukuvikela lezi zindlela ngokumelene nokuhlaselwa amaqembu anentshisekelo ahlukahlukene angathanda ukuwabona ethathwe emakethe.