Konke Okudingeka Ukwazi Nge-Thyroid Yokuvuselela I-Hormone Test
I-test ye-hormone test stimulating-eyaziwa nangokuthi ukuhlolwa kwe-TSH-iyisivivinyo esiyinhloko esetshenziswa ngabadokotela abavamile abaxilongwa nokuphathwa kwesifo se-thyroid. Kubalulekile ukuthi njengesiguli se-thyroid, uqonda lokhu kuhlolwa, incazelo yemiphumela yakho, kanye nezingxabano ezizungeze uhla lwezintandokazi ze-TSH.
Uyini umbuzo we-TSH?
Isivivinyo se-TSH silinganisa i-hormone noma i-TSH ye-thyroid.
I-TSH i-hormone ikhishwa yi-pituitary gland yakho ekuphenduleni amazinga we-hormone yegciwane egazini lakho legazi. Uma ama-hormone we-thyroid aphansi afunyanwa, i-pituitary ikhishwa ngaphezulu kwe-TSH ukukhuthaza igciwane lakho le-thyroid ukuze likhiqize ama-hormone amaningi. Uma i-hormone ye-thyroid ekhulu kakhulu itholakele, i-pituitary inciphisa ukukhiqizwa kwe-TSH.
Isivivinyo se-TSH yisilingo segazi lokuqala sokusetshenziswa kwegazi esetshenziselwa ukuxilonga isifo segciwane bese uphatha ukwelashwa kwegciwane. Ezingeni eliyisisekelo, amazinga aphakanyisiwe we-TSH abhekwa njengobungqina be-hypothyroidism, i-thyroid engasebenzi. Amazinga aphansi ka-TSH abhekwa njengobungqina bokuthi i-hyperthyroidism, i-thyroid engasebenzi kakhulu.
Ama-Rang Reference Ranges
Ibanga lokubhekisela litholakala ngokuthatha iqembu elikhulu labantu emphakathini, eqhuba uvivinyo oluthile, ukubala amanani, nokudala ububanzi obufanele ukumela amazinga "avamile" abantu abangenaso isifo esithile noma okungavamile .
Uhlu lwetheksthi le-TSH lumelela ububanzi bamazinga e- TSH abantu ababizwa ngokuthi banenkinga yesifo se-thyroid futhi abanomsebenzi ovamile we -roid.
Njengamanje, kuma-laboratories amaningi e-US, ibanga lokubhekisela lezinkinga ze-TSH cishe li-0.5 ukuya ku-5.0 mU / l. Kuye ngelebhu, ungase ubonakale umehluko othile, okungukuthi u-0.4 kuya ku-5,5 mU / l, noma u-0.6 kuya ku-4.5 mU / l, njll, kodwa ngokuvamile, u-0.5 kuya ku-5.0 mU / l kubhekwa njengama-lab.
Ngokuvamile, udokotela wakho uzohumusha izinga elingezansi kwe-0.5 mU / l njengendlela ekhombisa ukuthi i-hyperthyroidism (i-thyroid engasebenzi kakhulu), nezinga elingenhla ku-5.0 mU / l njengendlela ebonisa ukuthi i-hypothyroidism (i- thyroid engasebenzi ).
Ishadi elilandelayo libonisa ububanzi bokubhekisela kwe-laboratory ye-TSH:
| I-TSH Reference Range | Ukuhumusha |
| 0.5 kuya ku-5.0 mU / l | - Izansi ngezansi kwe-0.5 mU / l okubonisa hyperthyroidism - Izinga elingaphezulu kuka-5.0 mU / l lokubonisa hypothyroidism |
I-Reference Range Controversy
Uhla lwamarekhodi we-TSH langempela luphikisana iminyaka engaphezu kweyishumi. Emuva ngo-2003, ngemuva kokufakazela ukuthi iziguli ezaba namazinga e-TSH ekugcineni okuphezulu kobubanzi bezinkomba ze-TSH zazivame ukuqhubeka nokuthuthukisa i-hypothyroidism kaningi kunezo ezisekupheleni kwebanga, i-American Association of Clinical Endocrinologists (AACE) Kunconywa ukuthi odokotela "bacabangele ukwelashwa kweziguli ezivivinya ngaphandle kwemingcele ye-margin encane esekelwe izinga elibhekiswe ku-TSH lika-0.3 kuya ku-3.0 mU / l. Ngaleso sikhathi, i-AACE ikholelwa ukuthi uhla olusha " luyoba nokuxilongwa kahle kwezigidi zabantu AmaMelika aphethwe yisifo esibucayi se-thyroid, kodwa angaphathwa kabi. "
Ngokusho kukaMengameli we-AACE uHossein Gharib, MD,
Ukusabalalisa kwesifo se-thyroid esingatholakali e-United States kusaphazamisa phezulu ... Uhla olusha lwe-TSH oluvela emihlahlandleleni ye-AACE lunikeza odokotela ulwazi oludingayo ukuze bahlolisise isifo esibuhlungu ngaphambi kokuba kuholele emiphumeleni eyingozi kakhulu empilweni yesiguli, i-cholesterol ephakeme, isifo senhliziyo, ukuphefumula kwamandla, ukuphelelwa amandla, nokucindezeleka. "
Ngaleso sikhathi, isimemezelo esivela ku-AACE sabonakala ngabaningi njengokuthuthukiswa kwesikhathi eside nokudinga kakhulu iziguli.
Ngeshwa, lokho okwakucatshangwa ukuthi ukuthuthukiswa okwenziwe ngeziguli ze -roid akuzange kube nomthelela omkhulu, ngezizathu eziningana:
- Ama laboratories akakaze athathe uhla olusha njengoluhlu oluhlelekile lokubhekisela, okusho ukuthi amazinga kuphela ngaphandle kwasekudala, ububanzi obubanzi abukwa njengengavamile.
- Ukwakhiwa kwezokwelapha kwaqhubeka kungavumelani ngohla lwezintandokazi ze-TSH, njengoba kuboniswe yizihloko ezimbili ezivelele ezavela encwadini kaSepthemba ka-2005 ka- Journal of Clinical Endocrinology kanye neMetabolism , eveza izingxenye ezimbili zempikiswano.
Odokotela Martin Surks, uGayotri Goswami kanye noGilbert Daniels bathi i-reference reference kufanele ihlale ifana nalokho okushiwo "Ukuphikisana Endocrinology Clinic: I-Thyrotropin Reference Range Kufanele Ihlale Ingaguquki." Besebenzisa izimpikiswano zabo ngokufakazela kwabo ukuthi "ngoba ukwelashwa kwesifo se-levothyroxine akukhuthazwa nge-subclinical hypothyroidism, ngokuqinisekile akuqinisekisiwe kubantu abanezintambo eziphezulu ze-TSH" amazinga ka-2.5 kuya ku-4.5 mU / l.
Odokotela uLeonard Wartofsky noRichard Dickey bathi ku-athikili yabo, "Ubufakazi be-Narrower Thyrotropin Reference Range buphoqeleka," ukuthi izintambo ezisekelwe ngaphambili zangasesezivumelekile ngoba izithenjwa ezibhekwa ngaphambili zibhekwa zijwayelekile "zazingcoliswa" nabantu abanamazinga ahlukene ngesifo se-thyroid. Batshela ukuthi izinzuzo zokwelashwa zidlula zonke izingozi ezingezansi.
Odokotela Wartofsky noDickey bavikela ukushintshela ebangeni elisha, bethi:
Ngeke mhlawumbe singalokothi sibe ne-cutoff ye-value ngokuphelele ye-TSH ehlukanisa ukujwayelekile nokungajwayelekile, kodwa ukuqaphela ukuthi isilinganiso samanani ajwayelekile we-TSH kuphela phakathi kuka-1.18 no-1.4 mU / l nokuthi ngaphezulu kuka-95% wabantu abajwayelekile bayoba nezinga le-TSH ngaphansi ngaphezu kwe-2.5 mU / l ngokucacile kusho ukuthi noma ubani onenani eliphakeme kufanele ahlolwe ngokucophelela ngokuhluleka kwe-thyroid ekuqaleni.
Ngonyaka ka-2006, amaqembu e-endocrinology ashiye incomo yokwandisa uhla lwezintandokazi ze-TSH, Noma kunjalo, ingxabano elandelana emuva ibuye yaqhubeka iminyaka engaphezu kweyishumi, futhi kusukela ngo-2017, ukuphikisana kuyaqhubeka. Noma kunjalo, iningi labasebenzi bezempilo abavamile bayalwa ukuba basebenzise uhla lwe-TSH olubanzi lokubhekisela ekuhloleni nasekuphatheni iziguli ze-thyroid.
I-TSH evamile ne-Hypothyroidism
Kubalulekile iziguli ze-thyroid ukwazi ukuthi ucwaningo lubonise ukuthi:
- Esikhathini se-iodine-esanele abantu, kusho ukuthi i-TSH i-1.5 mU / l
- Ezicwaningweni zamaqembu omphakathi anezimo eziphansi zeHashimoto's thyroiditis, kusho i-TSH engu-1.18 mU / l
- Uma abantu abane-antibodies enhle ye-antithyroid noma umlando womndeni we-autoimmune isifo se-thyroid bangaphandle kwamanani okubhekisela ebhalweni, ibanga elijwayelekile lokubhekisela liqala ukusuka ku-0.4 kuya ku-2.5 mU / l
- Ngesikhathi sokukhulelwa, imihlahlandlela ithi amazinga ka-TSH akufanele aphakamise ngaphezu kwe-3.0, ukuze avikele impilo yomama nomntwana.
- Amazinga e-TSH ekupheleni okuphezulu kwereferensi yokubhekisela nawo ahlanganiswe nezingozi ezingaphezu komdlavuza wegciwane, i-cholesterol ephakeme, ukungabi nabantwana, isifo senhliziyo, uhlobo lwesifo sikashukela sohlobo lwesibili, kanye nezinye izinkinga zezempilo.
- Amazinga we-TSH avame ukuphakama ekuqaleni kosuku. Ukuhlolwa kwe-TSH okwenziwe kamuva ngosuku kungabonisa amazinga akho njengokungaphakathi kwohlu lokubhekisela, ngenkathi ukuhlolwa kwangaphambi kokuqala kungabonisa i-hypothyroidism.
Uma umphumela wakho wokuhlolwa we-TSH ungena ebangeni lokubhekisela futhi utshele ukuthi "i-TSH yakho iyinto evamile," ungabe usaba i-hypothyroid? Odokotela abaningi abavamile basho ukuthi cha, futhi ochwepheshe abaningi abahlangene nabaphelele bathi yebo. Kungakhathaliseki ukuthi ungaba i-hypothyroid ngezinga elijwayelekile le-TSH ekugcineni lihlala liyingxabano.
Izwi elivela
Njengoba ufunde, incazelo yezinga elithi "evamile" le-TSH lincike kudokotela obonisana nabo nemibono yakhe mayelana nesifo se-thyroid. Ngesikhathi esifanayo, ukuhlolwa kwe-TSH kanye ne-TSH yokubhekisela kubaluleke kakhulu empilweni yakho yezokwelapha kanye nokwelapha. Ngenxa yalokho, kukhona izinto ezibalulekile okufanele uzikhumbule.
- Udinga ukubuza ukuthi isiphi i- TSH esilinganisa udokotela wakho ekubhekisele kuwe, futhi kungani. Ungase ube nodokotela okholelwa ukuthi ukugcina phezulu kwebanga kuwumgomo oyedwa noma ogxila kwi-TSH ephansi nokusizwa kwezibonakaliso zakho. (Futhi, odokotela bahlose amazinga e-TSH aphansi kakhulu noma acindezelayo abanye abasindiswa ngumdlavuza we-thyroid, njengendlela yokuvimbela ukuphindaphindiwe komdlavuza.) Iningi labodokotela, namanje, basasebenzisa uhla lwe-TSH lokubhekisela kulo lonke u-0.5 kuya ku-5.0 ukuxilongwa nokuphathwa isifo sakho se-thyroid.
- Akufanele wamukele izimpendulo "ezivamile," "eziphezulu," noma "ezansi" njengombiko wokuhlolwa kwegazi lakho. Esikhundleni salokho, cela izinombolo zangempela bese ucela ibanga lokubhekisela lebhulabhu. Ngisho nakakhulu okwamanje, cela ikhophi yemiphumela yangempela yokuhlolwa kwegazi.
- Uma amazinga wakho wokuhlola we-TSH angaphakathi kwebala lokubhekisela, futhi unezimpawu ezihambisana ne-hypothyroidism, ungase ufune ukucela ukuhlolwa okungeziwe ukuze usize ngokuxilongwa ngokugcwele. Ngenkathi odokotela abavamile bexhomeke ekuvivinyweni kwe-TSH kuphela, abanye odokotela balinganisa ama-hormone e-thyroid (i-thyroxine (T4) ne- triiodothyronine (T3) - kanye namazinga we-antibody we-thyroid futhi abuyele emuva ku-T3. Laba odokotela bafuna izinyathelo ezengeziwe zokuthola ukuxilongwa. Isibonelo, uma amazinga akho ama-hormone e-T4 ne-T3 ephansi, kusolakala ukuthi i-hypothyroidism, futhi uma iphakeme, i-hyperthyroidism iyasolakala. Ama-antibodies-ikakhulukazi amasosha omzimba we-peroxidase (TPO) angakwazi ukuhlola isifo sikaHashimoto-ngezinye izikhathi akholelwa. I-subset of practitioners ikholelwa ukuthi isifo se-thyroid esesimweni sokuhluleka okuzenzakalelayo-njengoba kuboniswa ngamazinga aphezulu we-anti-TPO-angabangela izimpawu ze-hypothyroidism ngaphambi kokuba i-hypothyroidism iboniswe ku-TSH, noma ngisho ne-Free T4 ne-Free T3, ukuhlolwa. Baphinde bakholelwa ukuthi ukwelashwa ngezidakamizwa ezithathelanayo ze-hormone kungasiza ekunciphiseni izimpawu zakho, ukunciphisa amazinga akho e-antibody, futhi kukuvimbele ukuba ungaphezu kwe-hypothyroid.
- Uma amazinga wakho wokuhlola we-TSH awela ekugcineni okuphezulu kwereferensi yokubhekisela, futhi unezimpawu ezihambisana ne-hypothyroidism, cabanga ngokuxoxa ngesilingo sokwelashwa kwesimo se-hormone ye-thyroid nodokotela wakho.
- Uma udokotela wakho enqaba ukusebenzisa izivivinyo ezengeziwe noma enqaba ukukuphatha, cabanga ngokuthola udokotela omusha ukunakekela kwakho kwe-thyroid. Odokotela abahlanganisayo nabaningi bavame ukufaka izivivinyo eziningi ngaphezu kwesilingo se-TSH, bese uthatha umlando wakho wezokwelapha kanye nezimpawu, ngokufaka umgomo wokuthola i- TSH ephephile futhi enempilo ezosiza ngokukhululekile izimpawu zakho.
> Imithombo:
> Anderson et. I-"." Ukuhlukahluka Kwamanye Omunye Ku-Serum T4 no-T3 kwizihloko ezijwayelekile: I-Clue ekuqondeni izifo ze-Thyroid, "Journal of Clinical Endocrinology kanye neMetabolism, 87 (3): 1068-1072.
> Garber J, uCobin R, Gharib H, et al. Imikhombandlela yokusebenza emitholampilo ye-hypothyroidism kubantu abadala: I-Cosponsored yinhlangano yamaMelika ye-endocrinologists yemitholampilo kanye nomhlangano we-American thyroid. I-Endocrine Practice. 2012; 18 (6): 988-1028. doi: 10.4158 / ep12280.gl.
> I-Guber HA, i-Farag AF. Ukuhlolwa komsebenzi we-endocrine. Ku: McPherson RA, Pincus MR, eds. Ukuhlolwa Nokuphathwa Kwemitholampilo kaHenry's by Methods Methods. 22nd. Philadelphia, PA: Elsevier Saunders; 2011: isahluko 24.
> Surks, et.al. "Ukungqubuzana Endocrinology Clinic: I-Thyrotropin Reference Range Kufanele Uhlale Ungaguquki," I-Journal of Clinical Endocrinology ne-Metabolism 90 (9) / 5489-5496.
> Wartofsky & Dickey, "Ukuphikisana Endocrinology Yemithi: Ubufakazi Bokweqakathekile I-Thyrotropin Reference Range Kuphoqelela," I-Journal of Clinical Endocrinology ne-Metabolism.