Uma i-hypothyroidism ibeka ukulandela i-thyroidectomy noma ngemuva kokwelashwa nge-iodine yama-radioactive (RAI), noma uma uthola ukuthi une- thyroid engasebenzi ngenxa yokuzibulala ngokuzenzakalelayo i-Hashimoto's thyroiditis, kuyoba nemibuzo eminingi ebalulekile yokubuza udokotela wakho. Nazi ezinye eziyisithupha ezijwayelekile kakhulu futhi ezibalulekile.
1. Iyiphi ibanga elivamile le-hormone ye-thyroid (stimulating hormone) (TSH) ebhodini lakho?
Isivivinyo se- TSH yisilingo esivame ukusetshenziswa kakhulu sokuxilongwa nokuphathwa kwe- hypothyroidism e-United States.
Kodwa ama-labs ahlukene ngokuvamile anezindinganiso ezihlukile okwakwaziwa ngokuthi "uhla lwe-reference lwe-TSH." Lesi silinganiso ububanzi bezindinganiso zokuhlolwa ezithathwa njengokubonisa umphakathi ovamile.
Kulabhu amaningi, ububanzi bezinkomba ze - TSH bugijima kusuka ku-0.5 kuya ku-4.5. Inani le-TSH elingaphansi kuka-0.5 libhekwa njenge- hyperthyroid (i- thyroid engasebenzi ), kuyilapho inani le- TSH elingaphezu kuka-4.5 libhekwa njenge- hypothyroid (i-thyroid engasebenzi). 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 ozithola ngazo.
QAPHELA: Kusukela ekupheleni kuka-2002, i- American Association of Endocrinologists Clinic (AACE) kanye namanye amaqembu ochwepheshe baye baphindela emuva mayelana nezincomo zokunciphisa ububanzi be-TSH, ngakho-ke ku-0.3 kuya ku-3.0.
Kodwa odokotela abavumelani. Ngakho odokotela abathile babheka amazinga ngezansi .3 nangaphezulu kwama-3.0 njengobufakazi bokungasebenzi kahle kwegciwane. Abanye baqhubeka ukusebenzisa izindinganiso ezidala, lezo eziqhubeka zikhona kuma-labs amaningi.
2. Yisiphi izinga le-TSH ozolisebenzisa njengelitshe kimi?
Lo ngumbuzo olayishiwe kodwa obalulekile.
Impendulo yodokotela yakho izokwembulela yena noma ifilosofi yakhe ngokuthi yini emele izinga "elivamile" le-TSH. Abanye odokotela bakholelwa ukuthi ukuthola isiguli singena phezulu kakhulu ebangeni elijwayelekile kuyinjongo yokwelashwa kwe-hypothyroidism . Isibonelo, besebenzisa izinga le-4.5 TSH, abanye odokotela bakholelwa ukuthi ukubeka imithi ye-hormone esikhundleni somuthi ukuze uthole i-TSH yesiguli phansi kwezingu-4,5 (mhlawumbe mhlawumbe nje kufike ku-4.4) ingaba ukwelashwa okugcwele. Abanye odokotela empeleni banomuzwa wokuthi amazinga angaphansi kuka-10.0 "angaphansi kwe-hypclinical hypothyroidism" futhi akavumelani nokuphathwa.
Odokotela bahluka kulokho okuyizinga le-TSH ngaphakathi kobubanzi obujwayelekile abakholelwa ukuthi lenza okuhloswe kahle. Abanye abasebenzisa isibonelo, bangase bahlose izinga le-TSH phakathi kwe-1.0 no-2.0 ngokusekelwe ekuhlangenwe nakho kwabo okuphakamisa ukuthi iziguli zingazizwa zingcono kula mazinga.
Abanye odokotela balandela iziqondiso ezixoxwa ekuqaleni, futhi bakholelwa ukuthi ukwelashwa kwe-hormone ye-thyroid kufanele kuhlose izinga le- TSH elingaphezu kuka-3.0 kwiziguli ze-hypothyroid .
3. Ngiyiphi imithi oyilungisela yona?
Njengoba cishe awukwazi ukufunda umbhalo, uzodinga ukubuza! Umbuzo lapha kungukuthi udokotela wakho ukhetha igama lomkhiqizo noma imithi ejwayelekile.
Uma igama lomkhiqizo libekiwe, uzofuna ukwazi ukuthi udokotela wakho uchaze "akukho okufaka esikhundleni sobudala" noma "ukuhambisa njengoba kubhaliwe (DAW)." E-United States, izidakamizwa zegama elibizwa ngegama le-hormone le-hormone zihlanganisa:
- I-Levothyroxine (i-synthetic thyroxine / T4): i-Synthroid, i-Levoxyl, i-Tirosint, i-Unithroid, noma i-generic
- I-Liothyronine (i-synthetic triiodothyronine / T3): i-Cytomel, noma i-generic
- I-thyroid yemvelo yemvelo: Isikhali, i-Nature-throid, i-WP ye-Thyroid, noma i-NP ejwayelekile ye-Thyroid
Iziguli eziningi zinqunywe i-levothyroxine. Ochwepheshe be-thyroid baye baxwayisa iziguli nge- levothyroxine ejwayelekile . Ngenxa yokuthi kungenzeka ukushintshashintsha kwezinto ezikhona phakathi kwezidakamizwa negama lomkhiqizo kanye nokukwazi ukuthi iziguli zingathola imikhiqizo ejwayelekile uma ugcwalisa imiyalelo, i-ATA ne-AACE ineluleka ukuthi odokotela kufanele -
1) Iziguli eziqaphile ukuthi ukulungiselela kwabo i- levothyroxine kungashintshwa ekhemisi
2) Khuthaza iziguli ukuthi zihlale zilungiselela ukulungiswa kwe-levothyroxine uma kungenzeka
3) Qinisekisa ukuthi iziguli ziyaqonda uma zithola ukulungiswa okusha kwe-levothyroxine okuzodinga ukuphinda i-hormone ye-hormone ye-thyroid-stimulating (TSH) yokuhlolwa kwegazi emasontweni amane kuya ayisithupha kamuva ukuze inqume ukuthi idinga ukulungiswa komthamo owengeziwe
4. Singalindela masinyane kanjani ukukhululeka kwezimpawu, kanye nokwenza ngcono ukuhlolwa kwegazi lami, kunikezwe umthamo obekiwe?
Umbuzo oyinhloko lapha ukuthi ngabe udokotela wakho unikeza umthamo omncane we-substitution ye-thyroid futhi uhlose ukulungisa amazinga akho kancane kancane, noma ngabe uzama ukukufaka ebangeni elihle ngokushesha ngangokunokwenzeka. Kunezizathu ezizwakalayo zombili izindlela, kodwa njengesiguli kubalulekile ukwazi ukuthi yini ongayilindela.
Abanye odokotela bangakufaka emthamo ophansi kakhulu bese bekusho ukuthi uzozizwa kangcono emavikini amabili. Uma ngabe amasonto amabili efika futhi ungazizwa ungcono, ungase ucabange ukuthi umuthi awusebenzi. Kodwa ukwelashwa kungathatha isikhashana ukuqala ukusebenza.
Uma ungumuntu ophakeme, noma uma unomlando wezinkinga zenhliziyo, odokotela bazovame ukukuqala ngesilinganiso esincane kakhulu se-hormone ye-thyroid ukuze ukwazi ukukala impendulo yakho futhi ugweme ukwandisa inkinga yenhliziyo yakho.
5. Uzozihlola kangaki izivivinyo ze-thyroid kuze kube yilapho sithola amazinga ami emuva ebangeni lokubhekisela futhi elungile?
Okungcono, udokotela wakho uzohlala phezulu ekufikeni ebangeni elijwayelekile. Ezimweni eziningi, lokhu kusho ukuthi ukukubona njalo ngemva kwamasonto ayisithupha kuya kweziyisishiyagalombili ukuhlolwa kwegazi bese ulandela ukulungiswa kwesilinganiso sakho kuze kube yilapho uzizwa ungcono futhi amazinga akho aphezulu.
6. Ngemva kokuba ngisezingeni elingaphambili, ngiphakamisa kaningi ukuthi ngibuyele ukuhlolwa kwegazi ukuze ngiqiniseke ukuthi izidingo zami zokulinganisa azizange zishintshe?
Uma udokotela wakho ethi awudingi ukungena okungenani kanye ngonyaka, sekuyisikhathi sokuqala ukubuza ukuthi ubona udokotela ofanele. Ochwepheshe abaningi batusa ukuthi iziguli zihlolwe okungenani njalo ezinyangeni eziyisithupha ngonyaka wokuqala noma ezimbili, zilandelwa kanye ngonyaka emva kwalokho.
Izwi elivela
Kunombuzo owodwa owodwa obalulekile okumele ubuze: "Uma nginemibuzo phakathi kwe-aphoyintimenti, ngingaxhumana kanjani nawe? Uyazibuyisela izingcingo wena, noma ingabe abahlengikazi bakho babuyela izingcingo kuwe? Unayo ikheli le-imeyili elihambelana nawe neziguli? "
Lo mbuzo uzokusiza ukuba ulinganise ukuthi udokotela wakho uthola kanjani izinhlelo. Uma unenketho yokufuna udokotela ohlukile, impendulo yakho kadokotela kulo mbuzo ingakusiza ukunquma ukuthi wenzeni. Abanye odokotela bazobuya bebize futhi bazophendula ngisho ne-imeyili. Abanye bakhetha ukubhekisa yonke imibuzo kubahlengikazi (abangase banikele ngolwazi oluhle noma oluhle kangcono). Kodwa uma ufuna umuntu oyedwa, isevisi, ukulalela ngokucophelela lokho okushiwo udokotela wakho lapha. Uzothola umbono wokuthi yini ongayilindela.
Imithombo:
Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. I-WLL / Wolters Kluwer; 2012.
I-Garber, J, uCobin, R, Gharib, H, et. al. "Iziqondiso Zomtholampilo Zokusebenza Nge-Hypothyroidism Kubantu Abadala: I-Cosponsored yi-American Association of Endocrinologists Clinic kanye ne-American Thyroid Association." I-Endocrine Practice. I-Vol 18 No. 6 Novemba / Disemba 2012.