Ukubheka i-Natural Thyroid, i-Levothyroxine, ne-Innovative New Treatment Options
Umcwaningi owaziwa uDkt. Wilmar Wiersinga, encwadini kaJanuwari 2014 yephephabhuku lwezokwelapha i- Nature Reviews Endocrinology , unokubukezwa okuthakazelisayo kwamanye amashintshi abalulekile e-paradigm ekwelashweni kwe-hormone yokwelapha esikhundleni se- hypothyroidism eminyakeni yamuva. Ngifinyelele ezinye izici ezithakazelisayo kakhulu kulesi sihloko.
Izinkampani ezine zeParadigm
UDkt. Wiersinga ubonisa ukushintsha kwepharadigm ezine.
- I-Paradigm Shift yokuqala: I- Hypothyroidism yayingenakuphefumula kuze kube ngo-1891 eLondon, uDkt. George Murray wabuyisa kakhulu i-hypothyroidism esigulini ngokunikeza umjovo wezimvu zekhanda. Ngemuva kwalokho, imithi noma imithi yamakhemikhali eyosiwe noma eyomisiwe eqala ukusetshenziselwa ukwelashwa okusebenzayo kwe-hypothyroidism.
- I-Paradigm Shift yesibili: Kusukela ngo-1960 kuya ku-1988, ukusebenzisa imithi ye-thyroid ekhishwe ngamanzi kancane kancane, njengoba ukusetshenziswa kwe-levothyroxine kwanda. Ngo-1978, inani lemigomo ye-levothyroxine lidlulele imiyalelo yemvelo ekhishiwe. Ngo-1988, u-84% wabo bonke iziguli babethatha i-levothyroxine.
- I-Paradigm Shift yesithathu: uDkt. Wiersinga uchaza ukuthi ukuhlolwa kwesilwane kusukela eminyakeni yama-1990 kubonise ukuthi i-euthyroidism - ukufeza amazinga ajwayelekile e-T4 ne- T3 emathisini omzimba - ngemuva kokukhishwa kwe-gland yegciwane ayikwazanga ukufezwa nge-levothyroxine kuphela, kodwa futhi kwakudingeka i- liothyronine (T3) . Iziguli nabahlengikazi baye babika iziguli zenza ngcono ngokungezelela kwe- T3, noma kwi-thyroid ekhishwe ngamvelo , kodwa iningi lezilingo nocwaningo olwenziwe ngalesi sikhathi akutholakelanga ukuthi lezi zindlela zokwelapha ezihlangene zaziphakeme. UDkt. Wiersinga ukhombisa ukuthi kunezizukulwane ezenza ukuthi iziguli zithinte kakhulu ekuthatheni ukwelashwa okuhambisanayo - futhi uthi "uma izifundo ezengeziwe zingakwazi ukubona leli gciwane elithile leziguli ze-hypothyroid, ukushintsha kwesigcawu sesithathu ekwelapheni kwe-hypothyroidism kungase kwenzeke-mhlawumbe ukuphilisa ukusetshenziswa komuthi okwenziwe ngokwezifiso kulokhu kulungiselelwa. "
- I-Fourth Paradigm Shift : Ucwaningo olwenziwe ngo-2012 oluchazwe okokuqala ukuthi ukusebenza kwamathambo e-thyroid kungenziwa kumaseli e-embryonic stem. UDkt. Wiersinga ucacisa ukuthi "lo msebenzi ungaholela ekuguquleni kwesine, lapho iziguli ze-hypothyroid zingelashwa ngama-cell stem cells".
Levothyroxine kuphela Ukwelashwa
Lapho ekhuluma ngokushicilela kweparadigm, uDkt. Wiersinga wabheka ngokubheka kakhulu ukusetshenziswa kwe- levothyroxine (T4) kuphela . Wabonisa ukuthi kunezinhlobo zezifundo ezibonisa ukuthi ukwelashwa kwe-levothyroxine kuhlotshaniswa nenani lezinkinga ezigulini, kuhlanganise:
- ukucindezeleka kwengqondo okwandayo
- inhlalakahle enhle
- ukunciphisa izinga lempilo elihlobene nempilo
- ukukhubazeka kokuvinjelwa kwengqondo kwengqondo, ukunakwa, ukufunda nokukhumbula
- ukwandisa ukukhathazeka
- umsebenzi ompofu wengqondo, inkumbulo yokusebenza nokufunda
Ngokuyinhloko, ngokusho kukaDkt. Wiersinga, "Ukukhubazeka kwengqondo, ukucindezeleka noma ukukhathazeka kubonakala ku-5-10% weziguli ze-hypothyroid ezithola i-levothyroxine, naphezu kwamazinga ajwayelekile e-TSH ."
UDkt. Wiersinga naye ubika ngesifundo seScotland esithakazelisayo esathola ukuthi izinkinga zezinkinga zenhliziyo, izinkinga ze-arrhythmias, ne-bone thickness zanda kuziguli ezinamazinga e- TSH acindezelwe (ngaphansi kuka -03), nakuziguli ezinezinga eliphezulu le-TSH (ngenhla 4.0) kodwa kwakungekho ingozi ekhulayo ehambisana namazinga "aphansi" we-TSH (.04 kuya ku -4).
UDkt. Wiersinga wethule ucwaningo olubonisa ukuthi "amazinga ajwayelekile e-TSH ngenxa yalokho akuqinisekisi i-euthyroidism kuzo zonke izicubu ezihlose i-hormone yegciwane." Kalula nje: ukwelashwa kwe-levothyroxine kuphela kungase kungabi ukwelashwa okuhle kweziguli ezine-hypothyroidism. Esikhundleni salokho, ukungezwa okunye kwe-t3 kungasiza ukujwayelekile ukusebenza kwe -roid kuzo zonke izicubu.
Levothyroxine Plus Liothyroinine (T4 + T3)
Izifundo eziningana ezibheke ukwelashwa kwe-levothyroxine kuphela, ngokuhambisana nokwengezwa kwe-T3 ziye zabonisa ukuthi, ngokusho kukaDkt. Wiersinga, "isilinganiso esiphakeme kakhulu seziguli (ngokwesilinganiso sama 48%) sithanda ukwelashwa kokuhlanganiswa ... Ukungafani ku-serum yokugcina Amazinga we-TSH akakwazanga ukuchaza lokhu okukhethwe ngesiguli. "
Iziphetho
UDkt. Wiersinga uphetha ngokuthi "ingxabano ekholisayo ingenziwa ukuthi le nqubo yokwelashwa ingaba nezinzuzo uma i-levothyroxine: i-liothyronine dose ratios esebenzisayo eholela kumazinga ajwayelekile we-TSH ye-serum kanye ne-T4 yamahhala: ukulinganiswa kwamahhala we-T3" noma uma kunikelwa iziguli ezinomqondo othize izinkinga zofuzo ezithinta ikhono labo lokuguqula i-T4 kuya ku-T3.
Uphinde ukhuthaze ukuthi i- endocrinologists kufanele ibuke okukhethwa kukho, kuhlanganise nokwengezwa kwe-T3, ukusiza iziguli ze-hypothyroid ezinezimpawu eziphikisana naphezu kwemithi edingekayo ye-levothyroxine.
Ngokusho kukaDkt. Wiersinga, ukhetho olulodwa ukulandela imihlahlandlela ye-European Thyroid Association 's (ETA) yokusebenzisa okuthiwa "ukuhlola" ukusetshenziswa kwe- T4 + T3 yokwelashwa , okubandakanya isilinganiso se-levothyroxine kuya ku-liothyronine cishe ngo-17: 1 Ngokusho lesi sihloko, "isibonelo, i-TSH-normalizing levothyroxine amanani we-100 μg, 150 μg no-200 μg ngesikhatsi i-monotherapy ihumusha emithini yokwelashwa ehlanganisiwe ka-85 μg levothyroxine kanye no-5 μg i-liothyronine, 125 μg levothyroxine kanye ne-7.5 μg i-liothyronine ne-175 μg levothyroxine kanye no-10 μg liothyronine, ngokulandelana).
Babuye batusa ukwehlukanisa umthamo we-T3 wansuku zonke zibe ezimbili (umthamo omncane owenziwe ekuseni kanye nomthamo omkhulu owanikezwa ngesikhathi sokulala, ukulinganisa okuqondile ngokuya ukuthi yikuphi okusetshenziselwa ukutholakala kwe-liothyronine lapho ukhona khona) "ukusiza ukulinganisa isigqi sangaphakathi amazinga we-T3 mahhala, afinyelela phezulu ngo-3 ekuseni "
I-ETA iphinde iphakamise ukulungiswa kancane kwe-T3.
Amanye Amaphuzu Okuthakazelisayo
Nazi ezinye ezimbalwa amaphuzu asemuva ezithakazelisayo kusukela kulesi sihloko.
Imikhombandlela yokwelapha ye-hypothyroidism eyashicilelwa ema-1980s nakwa-1990 "ngokungaqondile" iphakamisa i-levothyroxine (yokwenziwa kwe-T4) futhi ingakhulumi neze ezinye izindlela zokwelapha iziguli. Okuthakazelisayo, yonke imihlahlandlela yokwelapha i-hypothyroidism eyashicilelwe kuma-2000s isasikhuthaza i-levothyroxine njengokwelashwa okujwayelekile, kodwa futhi iqukethe izigaba zithi kungani inhlanganisela ye- levothyroxine ne-liothyronine (T4 + T3) ehlanganiswa akufanele isetshenziswe.
Kukhona ukwanda kokwelashwa kwe-hypothyroidism. E-England, imiyalelo yamakhomoni e-thyroid aphindwe kabili phakathi kuka-1998 no-2007. E-Netherlands, inani labantu labasebenzisa izidakamizwa ze-thyroid likhuphuke ngo-53% phakathi kuka-2005-2011 - inani labantu baseDutch landa 2.1% kuphela ngaleso sikhathi.
Isibalo seziguli ezikwelapha kuphela e-levothyroxine sehlile kancane kusukela ngo-2005 kuya ku-2011 - futhi kuye kwaba nokwanda kancane kwenani leziguli ezenzweni zokwelapha T4 + T3 zokwenziwa.
Umthombo
Wiersinga, Wilmar. "Izinguquko ze-Paradigm ezithombeni ze-hormone zokwelapha esikhundleni se-hypothyroidism." Ukuhlolwa Kwemvelo Endocrinology (2014), Ishicilelwe ku-intanethi 14 Januwari 2014