Ukuphatha izifo ze-Thyroid ngesikhathi nangemva kokukhulelwa kwakho

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Ukuphatha Izifo Ze-Thyroid Ngesikhathi Nengemva kokukhulelwa: Imihlahlandlela

Isifo se-thyroid siyazi ukuthi sithinta izici eziningi zokukhulelwa kanye ne-postpartum impilo, kanye nempilo yengane yakho. Ngomzamo wokuhlela imikhuba ehlukahlukene futhi ephikisanayo ngokuphathelene nesifo segciwane nokukhulelwa, iziqondiso zomtholampilo zokuphathwa kwezinkinga ze-thyroid ekukhulelweni kanye nesikhathi sokuhamba kwesikhathi sanyatheliswa ngasekupheleni kuka-2011, futhi ngo-2016, kubhekwe njengencomo zamanje.

Iphephabhuku I- Thyroid yanyathelisa iziqondiso njengesihloko sekhasi le-47, esibizwa ngokuthi "Iziqondiso ze-American Thyroid Association yokuHlola nokuPhathwa kwezifo ze-Thyroid ngesikhathi sokukhulelwa kanye ne-Postpartum" . Lesi sihloko sihlanganisa ezinye izincomo eziyinhloko zeziqondiso, ezinomthelela obalulekile uma uhlakulela isifo segciwane ngesikhathi noma ngemva kokukhulelwa kwakho, noma wena obhekene nesifo se-thyroid ngaphambi kokukhulelwa.

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Okufanele Ukwazi Ngayo Ukuhlolwa Kwe-Thyroid ekukhulelweni

Ngokuvamile, ukuhlolwa kwe-thyroid kwenzalo kwabesifazane abakhulelwe akubhekwa njengelungile ngokwemihlahlandlela. Kodwa-ke, ochwepheshe basikisela ukuthi ukuhlolwa nokuhlolwa kuqhutshwe phakathi kwabesifazane ababhekene nengozi ephezulu yesifo segciwane.

Unengozi ephakeme yesifo segciwane ngesikhathi ukhulelwe uma:

• ube nomlando womuntu siqu we-dysfunction ye-thyroid kanye / noma ukuhlinzwa kwe-thyroid
• unomlando womndeni wesifo segciwane
• ube ne-goiter
• ukuhlolwa okunamandla kuma-antibodies ephakeme we-thyroid
• babe nezimpawu noma izimpawu zomtholampilo ezingase ziphakamise hypothyroidism
• unesifo sikashukela sohlobo lwami
• unomlando wokukhishwa kwesisu noma ukudilizwa kwangaphambi kwesikhathi
• unezinye izinkinga ezizimele ngokuzenzakalelayo ezivame ukuxhunyaniswa nezinkinga ze-thyroid ezizenzakalelayo, njenge-vitiligo, ukungasebenzi kahle kwe-adrenal, i-hypoparathyroidism, i-atrophic gastritis, i-anemia eyingozi, uhlelo lwe-systemic sclerosis, i-systemic lupus erythematosus nesifo se-Sjogren
• baye babhekana nokungabi nabantwana
• baye bathola imisebe ngaphambili emakhanda noma entanyeni njengokwelashwa komdlavuza, noma babe nama-x-ray amaningi wamazinyo
• zikhuluphele ngokweqile, ezichazwa njenge-mass mass index (BMI) engaphezu kuka-40, noma isisindo somzimba esingu-20% noma ngaphezulu ngaphezu kwesisindo somzimba esihle
• baneminyaka engu-30 noma ngaphezulu
• baye baphathwa nge-amiodarone (i-Cordarone) yezintando zenhliziyo yenhliziyo
• baye baphathwa nge-lithium
• ziye zavezwa iodini endaweni yokuhlolwa kwezokwelapha ukulinganisa ama-agent emavikini ayisithupha adlule,

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Okudingeka Ukwazi Nge-Hypothyroidism Nokukhulelwa

I-Hypothyroidism ngenkathi ukhulelwe ingaba nomthelela omkhulu wezempilo emntwaneni ongakazalwa, ngakho-ke i-hypothyroidism yomama kufanele igwenywe.

Uma u-hypothyroid ngaphambi kokukhulelwa, imihlahlandlela incoma ukuthi umthamo wakho ulungiswe ukuze i-TSH ingaphansi kwe-2.5 mIU / L ngaphambi kokukhulelwa . Lokhu kunciphisa ingozi ye-TSH ephakanyiswa ku-trimester yokuqala.

Kumele futhi uqinisekise ukukhulelwa kwakho ngokushesha, futhi ube necebo endaweni ukuze ukwandise imithi yakho yemithi ngokushesha , ukuze uvikele ukukhulelwa kwakho ngokusekela umsebenzi wakho we -roid.

Uma utholakala njenge-hypothyroid ngesikhathi ukhulelwe, kufanele uphathwe ngaphandle kokulibaziseka, ngenhloso yokubuyisela amazinga akho e-thyroid ngendlela evamile ngokushesha. Ngesikhathi se-trimester yokuqala, izinga le- TSH kufanele ligcinwe ezingeni eliphakathi kuka-0.1 no-2.5 ​​mIU / L, i-0.2 kuya ku-3.0 mIU / L ngesikhathi sesigamu sesibili, no-0.3 kuya ku-3.0 mIU / L ku-trimester yesithathu .

Ngesikhathi unamaviki amane kuya kwamathandathu ukhulelwe, umthamo wakho wemithi ye-thyroid uzodinga ukwanda, okungenzeka ube ngamaphesenti angama-50 .

Uma une-auto-immune disease ye-thyroid, isibonelo, ubuye wahlolisisa kakhulu ama-antibodies we-thyroid, usengozini yokuba i-hypothyroid kunoma yikuphi ukukhulelwa. Kufanele uhlolwe njalo ngokukhulelwa kwe-TSH ephakeme.

Uzophinde ufune ukuqaphela izinguquko ukulindela i-thyroid ngesikhathi ukhulelwe .

Esinye isincomo esibalulekile: qiniseka ukuthi i- vitamin yakho yokubeletha ihlanganisa i-iodine, isakhi esibalulekile somsebenzi we -roid ngesikhathi ukhulelwe.

Bheka isifingqo eningiliziwe seZikhombandlela ze-Hypothyroidism, izifo zikaHashimoto kanye nokukhulelwa .

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Okudingeka Ukwazi Nge-Hyperthyroidism Nokukhulelwa

Uma unamazinga we-TSH aphansi kunamajwayelekile, kufanele uhlolwe ukuze unqume ukuthi imbangela ye- hyperthyroidism ngesikhathi sokukhulelwa yilezikhathi ezincane hyperthyroidism / hyperemesis gravidarum - isimo sokukhulelwa esibangela ukugula okukhulu ekuseni - noma isifo se-Graves . Ukuxilongwa kwenziwa ngokunquma ukuthi unayo yini i-goiter, kanye / noma uvivinyo oluhle lwe-antibodies ye-thyroid.

Uma ukhulelwe, futhi uba yi-hyperthyroid ngenxa yezifo ze-Graves noma ama-nodules, kufanele uqale ukwelashwa kwe-hyperthyroidism ngokushesha. Ngokuvamile, uzothola ukwelashwa kwezidakamizwa ze-antithyroid (uma usanda kutholakala), noma, uma usuvele uphathwe, umthamo wakho uzoshintshwa ukuze amazinga akho e-T4 akholekile ahlale ebangeni elivamile lomuntu ongakhulelwe.

Isidakamizwa se-antithyroid esizikhethela (ikakhulukazi ngesikhathi sokuqala kwe-trimester) yi-propylthiouracil, ngoba i-methimazole inengozi encane kakhulu (nakuba encane kakhulu) yokubangela ukukhubazeka kokubeletha enganeni yakho. Lezi ziqondiso zincoma ukushintshela ku-methimazole kumakhomitha wesibili nowesithathu .

Uma unezimpikiswano ezimbi kakhulu ezidakamizwa ze-antithyroid, zidinga ukulinganisa okuphezulu kakhulu ukulawula i-hyperthyroidism yakho, noma ube ne-hyperthyroidism engalawuliwe naphezu kokwelapha, ukuhlinzekwa kunganconywa . Ngokuvamile ukuhlinzeka kwakunconywa phakathi nesikhombisa sakho sesibili, uma kungenakwenzeka ukuthi ungabe usengozini yokukhulelwa.

Inothi elibalulekile: Ukwelashwa kwe-iodine ye-radioactive akumele kunikelwe uma ukhona noma ungakhulelwa.

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Okudingeka Ukwazi Ngama-antibodies we-Thyroid, ama-Graves 'kanye nosana lwakho olusanda kuzalwa

Uma une-anti-STT-receptor-stimulating noma i-TSH anti-receptor-antibodies, ingawela i-placenta, futhi ithinte i-thyroid yengane yakho. Uma unomthelela kula ma-antibodies ngesikhathi ukhulelwe, ingane yakho ingazalwa nge-hyperthyroidism noma i-hypothyroidism . Lezi zinqamuzana kufanele zilinganiselwe uma unesifo se-Graves, noma ngabe uke wazalwa nezinsana owasungula isifo se-Graves. Kungase kudingekile ukukuphatha ngezidakamizwa ze-antithyroid ngesikhathi ukhulelwe ukuze unciphise ingozi kumntanakho.

Uma uye wakhulisa izifo ezithinta izidakamizwa ze-TSH-stimulating noma ze-TSH futhi ziphathwa ngezidakamizwa ze-antithyroid, ukuhlolwa kwe-fetal ultrasound kufanele kwenziwe. Le ultrasound kufanele ifune ubufakazi bokungasebenzi kahle kwegciwane emntwaneni wakho okhulayo, kufaka phakathi ukukhula okuncane nokukhula kwegciwane, phakathi kwezinye izibonakaliso.

Uma ungumama omusha enezifo ze-Graves, umntwana wakho osanda kuzalwa kufanele ahlolwe ukungasebenzi kahle kwegciwane ngemuva kokuzalwa, njengoba kunengozi yesimo esaziwa ngokuthi i- neonatal hyperthyroidism: eneziphumo ze-serioos ezinganeni ezisanda kuzalwa .

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Okudingeka Ukwazi Ngokugula Kwekusasa ne-Hyperthyroidism ekukhulelweni

Bonke abesifazane abakhulelwe abane-hyperemesis gravidarum (ukugula okusabalalisa okukhulu okuhlanganisa ukulahlekelwa kwesisindo esikhulu nokuphelelwa amandla kwamanzi) kufanele kube nokuhlolwa kwe -roid.

Uma unesifo esibi kakhulu ekuseni, futhi ukhululekile kakhulu ngenxa ye-Graves's disease, kanye ne-hyperthyroidism ye-gestational enezinga eliphakeme kakhulu le-hormone ye-thyroid - i-T4 yamahhala ngaphezulu kwebala lokubhekisela kanye no-TSH ngaphansi kuka-0.1 μU / ml - ungadinga ukwelashwa kwesikhashana nomuthi we-antithyroid.

Funda kabanzi mayelana ne-hyperthyroidism / i-hyperemesis gravidarum engapheliyo .

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Okudingeka Ukwazi Ngezidakamizwa Ze-Thyroid ne-Cancer Cancer ekukhulelweni

Ngokwemihlahlandlela, uma ukhulelwe futhi unezinyosi ze-thyroid, kufanele ube ne-TSH ne-Free T4 kulinganiswa. Uma unomlando womndeni we-medullary carcinoma yegciwane noma i-endocrine neoplasia (MEN) 2, amazinga e-calcitonin kufanele alinganiswe.

Imihlahlandlela ibuye iphakamise i-ultrasound ukucacisa izici ze-nodule, futhi iqaphe ukukhula. Uma i-nodule ingaphansi kuka-10mm ngosayizi, isifiso esihle senaliti (FNA) biopsy of thyroid yakho ayidingekile ngaphandle uma kukhona izici ezisolisayo.

Uma i-nodule ikhula, noma unekhwehlela ephikisanayo noma izinkinga zezwi, noma ezinye izinkomba ezisolisayo zomlando, Imihlahlandlela iphakamisa ukuthi i-FNA yenziwe. I-FNA ibhekwa njengokuphephile ngesikhathi sokukhulelwa.

Uma ama-nodules we-thyroid cancer efunyanwa ngesikhathi sokuqala kweyesithathu noma yesibili, ukuhlinzekwa kumele kuhlinzekwe ku-trimester yakho yesibili. Amakhansela we-thyroid ahlukaniswe kahle akhula kancane, ngakho-ke uma ukuhlolwa kubonisa ukuthi umdlavuza unamapilisi noma u-follicular, futhi abukho ubufakazi bokuthi izifo ezithuthukile, ungase unikezwe ithuba lokulinda kuze kube yilapho ingane yakho izalwa ngaphambi kokuhlinzwa.

Uma okwamanje futhi kuthiwa unesifo somdlavuza wegciwane, kwezinye izimo udokotela wakho uzokuncoma ukulinda kuze kube ngemva kokulethwa kokuhlinzwa. Kodwa ungathola ukwelashwa ngezidakamizwa ze-hormone esikhundleni se-thyroid, ukugcina i-TSH yakho iphansi, kodwa isabonakala. Okungcono, ama-T4 akho noma ama-T4 amazinga aphelele kufanele ahlale ebangeni elijwayelekile lokukhulelwa.

Iodine ye-radioactive akufanele inikezwe uma okwamanje ukhulelwe noma uncelisa.

Emva kokuthola umthamo wokwelashwa we-iodine omsakazo, kufanele ulinde izinyanga eziyisithupha ngonyaka ukuze ukhulelwe, ukuqinisekisa ukuthi umsebenzi wakho we-thyroid uzinzile, nokuthi umdlavuza wakho we-thyroid usuphelile.

Funda kabanzi mayelana ne- Thyroid Nodules ne-Cancer Cancer ekukhulelweni .

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Okudingeka Ukwazi Ngezinkinga Ze-Thyroid Post Postum

Uma unomlando we- postpartum thyroiditis , usengozini enkulu yokwenza i-hypothyroidism. Kufanele ube nokuhlolwa kwe-thyroid yonyaka.

Ngokuvamile, izidakamizwa ze-antithyroid azikhuthazwa isikhathi se-hyperthyroid se-postpartum thyroiditis. Uma unayo i-postpartum thyroiditis futhi unempawu, i-beta blocker ingasetshenziswa. I-beta blocker enconyiwe yi-propranolol, esenzweni esincane kunazo zonke ukuze kunqunywe izimpawu.

Imikhombandlela iphakamisa ukuthi emva kwesigaba sakho se-hyperthyroid, i-TSH yakho kufanele ihlolwe njalo ezinyangeni ezimbili kuze kufike unyaka owodwa ngemuva kokuhamba, ukuhlola i-hypothyroidism.

Uma izimpawu zakho zinzima, noma uma uhlela ukukhulelwa, i-hypothyroidism ebangelwa i-postpartum thyroiditis kufanele ilashwe. Uma ungenakuqhathaniswa, imihlahlandlela iphakamisa ukuthi i-TSH yakho ivuliwe njalo ngemva kwamasonto amane kuya kwangu-8.

Uma i-hyperthyroidism ivela ngemuva kokukhulelwa kwakho, imihlahlandlela iphakamisa ukuthi i-hyperthyroidism yakho iphathwe, kodwa ikhuthaza ukuthi uma kudingeka, ukukhethwa kokuqala kwemithi kube yisidakamizwa se-antithyroid esibizwa ngokuthi i-methimazole (igama lohlobo lwe-Tapazole). Ukufika ku-20 kuya ku-30 ​​mg / d kuthathwa njengokuphephile kumama okhulelwe nomntanakhe. Ukukhethwa kwesibili kwemithi ye-antithyroid ngemuva kokukhulelwa yi-propylthiouracil (eyaziwa ngokuthi i-PTU), ngamanani ukuya ku-300mg / d. Ochwepheshe banezinkinga eziningi mayelana nokusetshenziswa kwe-PTU ngenxa yezinkinga zobuthi besibindi ezihlobene nomuthi.

Uma unakekela futhi uthatha izidakamizwa ze-antithyroid, imihlahlandlela iphakamisa ukuthi imithi ye-antithyroid ihlukaniswe futhi ithathwe ngezikhathi zosuku olwenzeka ngemuva kokuncelisa. Uma uthatha izidakamizwa ze-antithyroid nokuncelisa, ingane yakho kufanele ihlolwe njalo ngezivivinyo zomsebenzi we-thyroid, ngokusho kwemihlahlandlela.

Ukuze uthole olunye ulwazi, bheka:

• I-Postpartum Thyrotoxicosis / Hyperthyroidism
• I-Postpartum Thyroiditis

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Okufanele Ukwazi Ngokusondeza Ngezifo Ze-Thyroid

Omama abaningi abasha bakhetha ukuncelisa. Uma unesimo se -roid, ungase uzibuze ngokuphepha kokuncelisa.

Uma uphathwa nge-hypothyroidism ngenkathi uncelisa , ungaqhubeka uthola imithi yokwelapha i-hormone ye-thyroid esikhundleni sakho esifanele ngaphandle kokulimaza ingane yakho .

Umbuzo wokuthatha izidakamizwa ze-antithyroid ye-hyperthyroidism ngenkathi ukondla ingxabano encane, futhi ungase ufune ukuhlolisisa lezinzuzo nezingozi.

Kufanele futhi uqaphele iziqondiso kanye nezinye izincomo ezithile mayelana nokuthi ungaphila kanjani ngokuphepha nge -roid ngenkathi ubeletha .

> Umthombo:

> Stagnaro-Green, Alex, futhi. al. "Imihlahlandlela ye-American Thyroid Association ye-Diagnosis kanye nokuphathwa kwezifo ze-Thyroid ngesikhathi sokukhulelwa kanye ne-Postpartum." I-Thyroid . Umqulu 21, Inombolo 10, 2011 (ku-intanethi)