Ukuhlola igazi kwe- hormone ye-thyroid (TSH) kubhekwa odokotela abathile ukuba babe yizona eziyinhloko-futhi kwezinye izimo ukuhlola okuwukuphela kwakho okudingayo ukuxilonga nokuphatha i-thyroid engasebenzi noma engasebenzi, eyaziwa ngokuthi i- hypothyroidism noma i- hyperthyroidism . Isivivinyo se-TSH ngezinye izikhathi sibizwa ngokuthi yi-endocrinologists evamile njengesivivinyo "sezinga elijwayelekile legolide" sokuthola nokuphathwa kwezimo ze -roid.
Ukuhlolwa kwe-TSH Kuyini?
Ukuhlolwa kulinganisa amazinga akho ka-TSH, i-hormone eyenziwa futhi ikhishwe yi-pituitary gland yakho. I-pituitary yakho inzwa ukuthi unayo i-hormone ye-thyroid eyanele engxenyeni yakho yegazi, futhi uma ithola amazinga anganele, i-pituitary yakho ikhishwa i-TSH ukuze ivuselele i-thyroid ukuze ikhulule i-hormone ye-thyroid. Yingakho i-TSH yakho iphakama lapho i-thyroid yakho ingasebenzi . I-TSH ephezulu isho ukuthi i-pituitary gland iyakhipha i-hormone yayo ukuze uzame ukuphendula i-thyroid ngokukhiqiza i-hormone engaphezulu yegciwane.
Ekupheleni okuphambene, lapho i-pituitary gland yakho izwa ukuthi kune-hormone yegciwane elidlula kakhulu, liyehla noma liyeke ukukhipha i-TSH. Ukunciphisa i-TSH kusho ukuthi i-thyroid yakho ayisatholi umlayezo wokukhulula i-hormone, futhi ukukhiqizwa kwe-hormone ye-thyroid kuyokwehla.
I-TSH Reference Range
Kusukela ngo-2017, kuma laboratories amaningi e-US uhla olusemthethweni lokubhekisela lwe-TSH test luqala kusukela cishe ku-0.5 kuya ku-4.5 noma ku-5.0 (mIU / L).
Isiguli esinezinga le-TSH elingaphakathi kwebhebula lokubhekisela libizwa ngokuthi "i-euthyroid," futhi kubhekwa ukuthi sinomsebenzi ovamile we -roid.
Ibanga lokubhekisela-futhi ngezinye izikhathi libizwa ngokuthi "uhla olujwayelekile" -yingxenye ebalulekile yocwaningo lwakho lwe-thyroid kanye nokwelashwa jikelele, ngoba izwe elivamile lokugcina i-endocrinology libhekwa njengento eyisihluthulelo sokuxilongwa nokuphathwa komsebenzi we -roid.
Isigaba Sokubhekisela Kwezi-TSH Sizimisele Kanjani?
Uhla lwezintandokazi ze-TSH luyatholakala ngokuthatha iqembu labantu emphakathini, ukulinganisa amazinga abo e-TSH, nokubala ububanzi obufanekisela ukuma kwezinga le-TSH emphakathini onempilo.
Ukusebenzisa uhla lokubhekisela olujwayelekile, i-TSH ngaphansi kwe-0.5 (i-TSH ephansi) ingaba yinkomba ye-hyperthyroidism (i-thyroid engasebenzi), kanti i-TSH ngaphezu kwe-4.5 / 5.0 (i-TSH ephezulu) ingabonisa i-hypothyroidism (i-thyroid engasebenzi).
I-TSH Reference Range Controversy
Enye yezindaba eziphikisana kakhulu kuye kwaba yinkinga yokuguqula "okujwayelekile" ibanga lokubhekisela kokuhlolwa kwe-TSH. Ekupheleni kuka-2002, i-National Academy of Clinical Biochemistry (NACB) yakhipha iziqondiso ezintsha zokuxilongwa nokuqapha isifo se-thyroid.
Emibhalweni, i-NACB ibike ukuthi ububanzi bezintandokazi ze- TSH bububanzi futhi empeleni kufakwe abantu abanesifo se-thyroid. Lapho ukuhlolwa okubucayi okwenziwe kakhudlwana kwenziwa, okungabandakanyi abantu abanesifo se-thyroid, amaphesenti angu-95 abantu abavivinywa babe nezinga le-TSH phakathi kuka-0.4 no-2.5. Ngenxa yalokho, i-NACB yakhuthaza ukunciphisa ibanga lokubhekisela kulawo mazinga.
Imihlahlandlela ye-NACB ibangele ukunconywa ngoJanuwari 2003 yi-American Association of Clinical Endocrinologists (AACE), ecela odokotela ukuba "bacabangele ukwelashwa kweziguli ezivivinya ngaphandle kwemingcele yemingcele encane esekelwe izinga elithengisiwe le-TSH lika-0.3 kuya ku-3.0. " Lesi sitatimende sathi: "I-AACE ikholelwa ukuthi uhla olusha luzoholela ekutholeni kahle izigidi zabantu baseMelika ababhekene nesifo esibucayi se-thyroid, kodwa abazange baphathwe kuze kube manje."
Ucwaningo olwanyatheliswa kuyi- Journal of the American Medical Association ngo-2003, uDkt. Vahab Fatourechi nabanye abacwaningi babecabanga ukuthi uma lolu hlu luhlanjululwa ngokulandela izincomo ze-AACE, inani labantu abanesifo segciwane liyokhula kusuka cishe ngamaphesenti amahlanu inani labantu elilinganiselwa kumaphesenti angu-20 labantu, kanti iningi lalaba bantu abanesifo esingeziwe labawela esigabeni se-hypothyroid / esingasebenzi.
Lokhu kubonisa ukunyuka okukhulu kwenani leziguli ze -roid emhlabeni wonke, kusukela ku-million ezilinganiselwa ku-15, kuya ku-60 million baseMelika.
Ngesikhathi esifanayo, inkomfa yokuvumelana eyenziwe ngabameleli abavela emaqenjini ochwepheshe abathintekayo ekwelapheni kwe-thyroid-kuhlanganise ne-American Association of Clinical Endocrinologists, i-American Thyroid Association, ne-Endocrine Society-yakhiphe imiphumela yabo ngo-2004, ikhuthaza ukwelashwa njalo ngeziguli ezinezinga le-TSH lika-4.5 kuya ku-10.0 mIU / L. Isinyathelo esisha sokubhekisela kwebheyisenti sishiywe.
Cishe eminyakeni engamashumi amabili kamuva, ama-laboratories aseMelika ahlolisisa asebenzisa i-age reference reference futhi odokotela bahlala behlukaniswe. Phakathi kwadokotela abavamile, iningi liyaqhubeka ukwenqaba ukuxilonga i-hypothyroidism ngaphandle kokuthi imiphumela ye-TSH yokuhlolwa ingaphandle kwebala lokubhekisela lendabuko futhi lichazwe njengelingavamile yi-laboratory.
UJeffrey Garber, MD, i-FACE, wakhuluma ngokuphikisana egameni le-American Association of Clinical Endocrinologists (AACE). Ngokusho kukaDkt. Garber, iziqondiso azisho ukuthi zisebenze njengengxenye yokugwetshwa komkhuba womuntu ngamunye. Ngenkathi emibhalweni yakhe enyathelisiwe, uDkt. Garber uthe akazwa sengathi ukuphatha i- hypclinical hypothyroidism ngokuvamile kuvumelekile, wathi ngokusemthethweni, akangabazi ukuphatha isiguli nge-TSH ngaphakathi kwereferensi uma ehlulela ukuze kube usizo.
Wathi i-Garber:
Ibanga elijwayelekile le-TSH akufanele libe yinkinga yokuhoxisa. Kodwa njengoba kubonakala njalo emithini yezokwelapha, kulula ukuvumelanisa ngokweqile. Uma usondelana nalokho okukude, kuyisimo esinzima. Kudingeka siqaphele ukuthi kungukuqhubeka. Uma abantu bebazi ukuthi leli qembu elithile lingase libe nesifo segciwane kuneqembu eliphansi, akukwenzi ukuba ukwelashwa futhi akusho ukuthi akufanelekile, lithi ukulilandela, futhi mhlawumbe lingenele.
Inselelo Yabagulayo: "I-TSH Yakho Yivamile"
Inkinga yezinhlawulo zezintandokazi ze-TSH ibeka izinselele kuwe njengesiguli.
Uma udokotela wakho ethola umbiko wakho wokuhlola emuva, noma yini ngaphakathi kwebala lokubhekisela ngeke lihlatshwe umkhosi njengelijwayelekile. Lokhu kusho ukuthi, uma udokotela wakho ethembele kumazinga ahlatshwe umkhosi futhi enza kuphela kumazinga angaphandle kwebala lokubhekisela, ngeke utholakale noma uphethwe ukwelashwa kwakho.
Ekugcineni, utshele ukuthi ukuhlolwa kwakho kwe-TSH "okuvamile" akuyona imininingwane ewusizo. Okudinga ngempela ukwazi kusuka kudokotela wakho izimpendulo zemibuzo emine ebucayi:
- Yayiyini inombolo yami yomphumela wokuhlolwa ka-TSH ?
- Iyini ibanga lokubhekisela ebhodini lapho imiphumela yami yokuhlolwa isetshenziswe khona?
- Uluphi uhla lokubhekisela olulandelayo ekuhloleni nasekulawuleni isifo se-thyroid?
- Iyini izinga lakho le-TSH elibhekele ukulungiswa okungcono kakhulu nokuphephile kwezimpawu zami?
Qinisekisa ukuthi uthola izimpendulo ezithile kule mibuzo ngaphambi kokuba uvumele udokotela wakho ukuba akhiphe inkinga ye -roid, noma akutshele ukuthi i-thyroid yakho "evamile," ikakhulukazi uma ubona izimpawu .
Izwi elivela
Uma ubhekene ne-endocrinologists noma abanye odokotela abenqikazi ukuxilongwa nganoma iyiphi enye indlela kunokuhumusha okuqinile kwemiphumela ye-TSH, kungase kube yisikhathi sokuthola umbono wesibili ku-endocrinologist, noma ukwandisa usesho lwakho ukuze ufake i-MD ephelele, udokotela osteopathic , noma i- naturopath eqeqeshiwe nelayisensi .
Abasebenza ngokugcwele bafaka izici eziningi ezingaphezu kwe-TSH test in the diagnosis kanye nokuphathwa kwesifo segciwane, kuhlanganise:
- Ukuhlolwa kwegazi okwengeziwe , njenge- T4 yamahhala, i-T3 yamahhala, namaphrofayli e-antibody
- Ukuhlolwa kwemitholampilo yezibonakaliso zakho ezibonakalayo zesifo se-thyroid, kuhlanganise nezinguquko ekuziphendukeni, ukuvuvukala kanye ne-edema ebusweni bakho kanye nemikhakha, ukulahlekelwa izinwele ekhanda nomzimba, ukulahlekelwa kwemiphetho yangaphandle yamashiya, ukwandiswa kwegciwane, ukushintsha kwamehlo, ukushaya kwenhliziyo, ukucindezeleka kwegazi, nezinye izimpawu ezilinganiselwe
- Ukucubungula ukuhlola ukukhomba ukukhuliswa kwe-thyroid , i-atrophy, nama-nodules
- Umlando wezokwelapha komuntu siqu nomndeni
- Umgomo wokwelashwa wezinga "eliphezulu" le-TSH nokuxazulula izimpawu
> Imithombo:
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. I-WLL / Wolters Kluwer; 2012.
> Fatourechi V, Klee GG, Grebe SK, et al. Imiphumela yokunciphisa umkhawulo ongaphezulu wamanani ajwayelekile we-TSH. I-JAMA. 2003; 290: 3195-3196.
> Garber, J, Cobin, 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.
> Gursoy A, futhi. al. "Yiliphi izinga le-hormone elivuselela i-thyroid kufanele lifunwe kwiziguli ze-hypothyroid ngaphansi kwe-L-thyroxine yokwelashwa esikhundleni?" I-Int J Clin Pract. 2006 Jun; 60 (6): 655-9