I-T4T3 yokulahlekelwa kwesisindo? Ucwaningo Lukhombisa Ukwelashwa Kwe-Combo Okuwusizo
Ulwazi oluvamile phakathi kweziguli, kanye nabanye ochwepheshe bezokwelapha, ukuthi inani elikhulu leziguli ezine- hypothyroidism lizoqhubeka nezikhalazo nezimpawu ezihlukahlukene, naphezu kokwelashwa nge-levothyroxine egcina okuthiwa "evamile" amazinga we-hormone (TSH) okuthiwa "evamile".
Ucwaningo olulodwa lwathola ukuthi, uma kuqhathaniswa nezilawuli, abangaphezu kuka-13% babengenelisekile ngempilo yabo, babonisa ukunganeliseki ngemithi yabo.
Izikhalazo eziyinhloko zazikhathala, inzuzo yesisindo , izinhlungu zomzimba / izinhlungu, nokuhlushwa.
NgokukaDkt. Bente Appelhof, MD, ovela eNyuvesi yase-Amsterdam eNetherlands kanye nosebenza nabo: "Ukuphikisana kusele ngokubaluleka kokwelashwa okuhlangene ne-LT4 ne-LT3, kuqhathaniswa ne-LT4 yodwa, ku-primary hypothyroidism. umqondo wokuthi isilinganiso esilungile seziguli ezine-hypothyroidism sisaqhubeka nezikhalazo zezempilo, naphezu kokwelapha okufakelwa i-levothyroxine nokujwayelekile kwe-serum TSH [i-hormone ye-thyroid-stimulating]. "
Ezinye izifundo zezilwane ziye zabonisa ukuthi ukwelapha okunye okufakelwa i-levothyroxine (LT4) yodwa akuqinisekisi ukuthi i-euthyroidism - amazinga ajwayelekile wegciwane - kuzo zonke izicubu. Esikhundleni salokho, i-euthyroidism ingatholakala kuphela ngokuphathwa kokwelashwa kwe-LT4 ne-liothyronine (LT3). Ucwaningo oluningi luye lwagxila kulokhu, ukubhekisisa ukuthi ukuguqulwa kwe-LT4 kungase kungabi yini okwanele ukubuyisela i-euthyroidism ezakhiweni zabantu.
Ngenkathi iziguli zibika ngokuqhubekayo izintandokazi zezifundo ezihlangene, abacwaningi abakwazi ukuhlukanisa isici esithile sokuthuthukisa esitholakala ngokomtholampilo.
Manje, abacwaningi baye babona okungenani okukodwa okubonakala kubhekene nokwelashwa okuhlangene - ukulahlekelwa isisindo.
Ucwaningo olwanyatheliswa kuyi- Journal of Clinical Endocrinology ne-Metabolism lubike ngesifundo esathola ukuthi iziguli zikhetha ukwelashwa kwe-thyroid okuhlanganisa inhlanganisela ye-levothyroxine (T4) ne-T3, kunokwelashwa okuvamile kwe-levothyroxine (T4 kuphela), futhi ukwelashwa okuhlanganisiwe kwakuhlobene ngesisindo.
Leli cwaningo elikhulu lomtholampilo liqinisekisile ukuthola okuvela ekutadisheni kweBunevicius, eyanyatheliswa eNew England Journal of Medicine, eyathola umphumela ozuzisayo we-T4 / T3 yokwelashwa kwe-hypothyroidism.
Isivivinyo somtholampilo esiphenduka kabili, esingenangqondo, esilawulwayo sibheke iziguli eziyi-141 ezinezici eziyinhloko zokuzimela nge-hypothyroidism, ezahlukunyezwa zaba amaqembu aphethwe nge-T4 / T3 ngokulinganiselwa ko-5: 1, 10: 1, kanye neqembu eliqhubekayo ngezokwelapha zabo zangaphambili ze-T4 kuphela. Ngemuva kwamaviki angu-15, lolu cwaningo lubonise ukukhetha okucacile ngengxenye yeziguli zezokwelapha ezihlanganisiwe, futhi ikakhulukazi, ukwelashwa okungu-5: 1 okunezinga eliphakeme le-T3, ngokuphathelene nokwelashwa kwe-T4 kuphela.
Okunye okutholakele okuthakazelisayo:
- Ukuncipha kwesisindo somzimba - kodwa hhayi ukwehla kwe-TSH ye-serum kwakuhambisana nokwaneliseka okwengeziwe ngemithi yokutadisha.
- Kuzo zombili amaqembu ahlangene, kwakunciphisa isisindo, okukhulunywa kakhulu eqenjini leqembu lesi-5: 1, elinesilinganiso esinciphile esingu-1.7 kg, noma ama-3.75 amakhilogremu. Iqembu le-10: 1 linesisindo sokulahlekelwa kwesisindo samakhilogremu angu-1. Iqembu le-T4 kuphela lalingenalo ushintsho esisisindo.
- Kulezi ziguli ezikhetha ukwelapha okuhlangene, 44% yayine-serum ye-TSH engaphansi kuka-0.11.
- Izinguquko ezingaguquguqukayo zemizwelo, ukukhathala, inhlalakahle, nemisebenzi ye-neurocognitive ayikwazanga ukuboniswa ukuchaza okukhethwa kweziguli ngenqubo yokwelapha.
Enye iphutha eliyinhloko ekutadisheni kwaba ukuthi ezinye iziguli ezithola ukwelashwa okuhlanganisiwe zithola amanani okucindezelayo, okubhekwa njengokunakekelwa ngokweqile. Babenamazinga we-TSH ngaphansi kwebanga elijwayelekile, ngakho-ke bekungabhekwa njengengqondo ye-hyperthyroid.
"Iziguli zithandana ukwelashwa kwe-LT4 / LT3 ehlangene nokwelapha okuvamile kwe-LT4, kodwa ukushintsha kwemizwa, ukukhathala, inhlalakahle, nemisebenzi engazi lutho akukwazi ukuchaza ngokucacile ukuthi kungani umphumela oyinhloko uhambele ukwelapha okuhlanganiswa kwe-LT4 / LT3," abalobi babhala. "Ukuncipha kwesisindo somzimba kwahlanganiswa nokwaneliseka ngemithi yokutadisha."
Ngesikhathi abalobi bezocwaningo behluleka ukuthola noma yisiphi isizathu esilinganiselwe sokuncoma ukwelashwa okuhlangene, baphetha ngokuthi: "Noma kunjalo, umphumela walolu cwaningo awuvimbeli ukuthi kungenzeka ukuthi iqembu elithile leziguli lingathola inzuzo yokwelapha i-LT4 / LT3 ehlanganisiwe."
Imithombo:
Appelhof BC, et. al. "Ukwelashwa okuhlanganisiwe ne-levothyroxine ne-liothyronine ngezilinganiso ezimbili, uma kuqhathaniswa ne-levothyroxine monotherapy e-primary hypothyroidism: isilingo somtholampilo esiphezulu, esingahleliwe, esingahleliwe."
Saravanan et. al. Inhlalakahle yengqondo ezigulini ezinokulingana 'okwanele' kwe-l-thyroxine: I-Clin Endocrinol (Oxf) 57: 577-585)