I-Hypothyroidism (i-thyroid engasebenzi ngaphansi) iyimpilo engathà sina yokwelapha engathinta kakhulu impilo yakho. Ngaphezu kokuvame ukudala izimpawu eziningi ezinzima (kubandakanya ukuzuza kwesisindo, izinwele kanye nokushintsha kwesikhumba, ukuqothulwa noma isifo sohudo, ukungakwazi ukukhulelwa, ukukhathala, nezinhlungu kanye nezinhlungu), i-hypothyroidism ingabuye ikhiphe izinkinga zempilo ezibucayi ezihilela inhliziyo kanye namaphaphu, isimiso somathumbu, isimiso sezinzwa, amehlo, nemisipha.
Ngaphezu kwalokho, kungabangela ushintsho oluhlukahlukene lwezinto ezihambisana nokuqukethe i-hyponatremia (ukuhlushwa okuphansi kwe-serum sodium), amazinga e-cholesterol aphakanyisiwe , nokwanda kwe-serum creatinine (umsebenzi wezinso wezinso). I-hypothyroidism enamandla ingabangela ngisho nezinguquko zengqondo, i-coma, nokufa.
Uma une-hypothyroidism, kubalulekile kuwe nodokotela wakho ukuba uphathe ngokwanele lesi simo ukuze unciphise izimpawu zakho, nokunciphisa nokuvimbela lezi zinkinga ezehlukene zezokwelapha.
Yiziphi Izinjongo zokwelashwa?
Imigomo yokwelapha i-hypothyroidism ilula. Kunjalo:
- ukujwayela amazinga e-hormone ye-thyroid (ngokuqondile, amazinga we-T4, T3 ne-TSH)
- ukuqeda izimpawu ze-hypothyroidism
- ukuma nokuguqula noma yikuphi imiphumela i-hypothyroidism ingaba nezinhlelo ezihlukahlukene zemizimba
- uma i-goiter ikhona (njengoba ngezinye izikhathi kunjalo ngesifo sikaHashimoto , isibonelo), ukunciphisa usayizi wayo
Indlela Ukwelashwa Kufezwa Ngayo?
Emaphepheni, ukwelashwa kwe-hypothyroidism kuhle kakhulu.
Iphathwa ngokubeka umlomo wokulungiselela i-hormone ye-thyroid (ngokuvamile i- levothyroxine, edayiswa njenge-Synthroid , ukulungiswa kwe-T4), yesilinganiso esanele ukubuyisela amazinga e-hormone ejwayelekile we-thyroid, ngaphandle kokukhiqiza ubuthi obuvela kumahomoni amaningi wegciwane.
Kodwa-ke, ngokwenza ukuphathwa kahle kwe-hypothyroidism kuye kwabangela ukuphikisana okulinganayo.
Izingxabano ezinkulu ziphindwe kabili:
- Yeka ukuthi kufanele uphakamise kangakanani amazinga e-TSH ngaphambi kokuba ucabange ukuthi i-hypothyroidism kufanele iphathwe ngendlela efanele?
- Ingabe ukuthatha i-T4 yedwa ngokwanele, noma kufanele i-T3 iphinde ibekwe?
(Ukusiza ukugcina ama-hormone e-thyroid eqondile, funda ukubuyekezwa okusheshayo kwegciwane le-thyroid, iT4, T3, ne-TSH .)
Sizocubungula kokubili lezi zincikiswano ngemuva kokuqala ukubheka "ukwelashwa" okujwayelekile kwe-hypothyroidism.
I-Standard 'Ukwelashwa kwe-Hypothyroidism
I-endocrinologists (ochwepheshe ezinkingeni ze-hormonal) cishe yonke indawo batusa ukuphatha i-hypothyroidism ne-T4 yedwa. Odokotela abancane, abanempilo ngokuvamile baqala ngalokho okucatshangwa ukuthi "isilinganiso esiphelele sokuthatha indawo" se-T4 (okungukuthi, umthamo okufanele uvuselele umsebenzi we -roid ngokujwayelekile). Isilinganiso esiphelele sokuguqulwa silinganiselwa ngokusho kwesisindo somzimba, cishe i-1.6 mcg ngekg. Kubantu abaningi lokhu kuzoba phakathi kuka-50 no-200 mcg ngosuku.
Kubantu asebekhulile noma abantu abane- coronary artery disease , ukuqaliswa kwe-thyroid esikhundleni sokwelashwa ngokuvamile kwenziwa kancane kancane; kusukela ngo-25-50 mcg nsuku zonke, futhi ukwandisa umthamo ngokuhamba kwesikhathi.
Abantu kufanele bathathe i-T4 esiswini esingenalutho, ngaphandle kwalokho ukumunwa kwemithi kuyoba okungaqondakali.
Ngokujwayelekile, odokotela batusa ukuphuza imithi kuqala ekuseni, bese ulinda okungenani ihora lokudla kwasekuseni (noma ngisho nokuphuza ikhofi). Ukuthatha imithi ngesikhathi sokulala, amahora ambalwa emva kokudla kokugcina, kubonakala sengathi kusebenza, futhi kungase kube indlela elula kakhulu kubantu abaningi. Funda kabanzi mayelana nesikhathi sokuthatha imithi ye-thyroid .
Amazinga we-TSH ahlolwe ukusiza ukwandisa umthamo we-T4. I-TSH-thyroid evuselela i-hormone-ikhiqizwa emthonjeni we-pituitary ngokuphendula ama-hormone we-thyroid. Ngakho-ke, lapho ama-hormone e-thyroid ephansi (njengase-hypothyroidism), amazinga e-TSH aphendula ngokukhula, ngomzamo wokubamba "i-hormone" ye-thyroid ngaphezulu kwegciwane le-thyroid.
Uma i-hypothyroidism ikwelashwa ngokwanele, amazinga e-TSH ngokuvamile ahlehla emuva ebangeni elijwayelekile. Ngakho-ke, okuyisisekelo ekunqumeni umthamo omkhulu we-T4 ukukala amazinga we-TSH .
Nakuba izimpawu ze-hypothyroidism zivame ukuxazulula ngaphakathi kwamasonto amabili okuqala ukwelashwa, kuthatha cishe amasonto ayisithupha amazinga e-TSH ukuze azinze. Ngakho-ke, amazinga e-TSH ngokuvamile alinganiswa amasonto ayisithupha ngemva kokuqala ukwelashwa. Uma amazinga e-TSH ahlala ngaphezu kwebanga elihlosiwe, umthamo we-T4 unyuke ngo-12-25 mcg ngosuku, futhi amazinga we-TSH aphindaphindiwe ngemva kwamasonto ayisithupha. Le nqubo iqhutshwa kuze kube yilapho isigaba se-TSH sifinyelela ebangeni elifunayo, futhi izimpawu zixazululwa. Uma isilinganiso esiphezulu se-T4 sixazululwe, amazinga e-TSH alinganiswa njalo ngonyaka noma ngaphezulu kwalokho, ukuqinisekisa ukuthi ukwelashwa kuhlala kulungiswe.
Kunezinhlobo ezahlukene ze-T4 ezenziwe ngabakhiqizi abahlukene. Ngenkathi zonke izinhlobo ze-FDA ezivunyiwe zikwahlulelwa ukuthi zifanelekile, ochwepheshe abaningi bancoma ukuthi banamathele ekubunjweni okufanayo, futhi bangashintshi, ngoba izilinganiso zesilinganiso zingahlukahluka phakathi kwamalungiselelo ahlukene.
Ngakho-ke, lokhu kuyindlela ejwayelekile yokwelapha i-hypothyroidism, futhi futhi, kuhle kakhulu. Kubonakala kusebenza kubantu abaningi; okungukuthi, le ndlela yokwelashwa ibangela ukuxazulula izimpawu nokubuyiselwa kwamazinga e-hormone ejwayelekile wegciwane kubantu abaningi abane-hypothyroidism.
Kodwa hhayi kubo bonke. Futhi yilapho izingxabano zingena khona.
Ukuphikisana: Kuyini okubhekiswe ku-TSH?
Njengoba sibonile, ukulinganisa amazinga ka-TSH kuyisisekelo esincane ekuhloleni ukwanela kokwelashwa kwesifo se-thyroid.
Kodwa akubona wonke umuntu ovuma ukuthi "uhla olujwayelekile" luni ngamazinga we-TSH . Iningi lemikhakha enkulu ye-endocrine ithatha uhla olujwayelekile lokuba phakathi kuka-0.5-4.5 (noma ngisho no-5.0) mIU / L. Kodwa-ke, iqembu elikhulu eliphikisanayo (i-American Association of Endical Endocrinologists) lichaze ukuthi uhla oluphezulu olujwayelekile kufanele linciphise libe ngu-3.0 mIU / L. Abantu abanamazinga e-TSH aphezulu kunalokho umkhawulo ongaphezulu, baye bathi, empeleni kungaba i-hypothyroid.
Lo mbuzo ubalulekile ngezizathu eziningana, kepha (njengoba sibonile) omunye wabo wukuthi, uma ukwelapha i-hypothyroidism, kubalulekile ukwazi ukuthi izinga le-TSH ngenkathi ekwelapheni libhekene nokujwayelekile, noma cha. Uma izinga lakho le-TSH eliphathwayo lingu-4.2 mIU / L, ngokweziningi ze-endocrinologists uphathwa ngendlela efanele; kodwa ngokubambalwa okubalulekile udinga isilinganiso esiphezulu sehomoni ye-thyroid.
Ngakho-ke, le mpikiswano eqhubekayo ingase iphoqelele ukwelashwa kwe-hypothyroidism.
Ukuphikisana: Ingabe i-T4 Yodwa iyanele noma kufanele i-T3 ihlinzekwe?
I-T4 iyinhloko enkulu ye-hormone ye-thyroid, kodwa akuyona i-hormone esebenzayo. I-T4 iguqulwa ibe yi-T3 kuzicubu, njengoba kudingeka. Futhi i-T3 yi-hormone ye-thyroid eyenza wonke umsebenzi. (I-T4 "nje" iprohormone-indawo yokugcina i-T3, indlela yokuqinisekisa ukuthi i-T3 enokudalwa ingahle isakhiwe ngomzuzu owodwa kuya kwemizuzu njengoba kuyadingeka.)
Uma sinika i-T4 hhayi i-T3, "sithemba" izicubu zomuntu ophethe i-hypothyroidism ukuguqula isamba esifanele esingu-T4 kuya ku-T3, endaweni efanele futhi ngesikhathi esifanele. (Eqinisweni, lokhu kuyi-endocrinologists eyinhloko yokusebenzisa ngokunikeza i-T4 yedwa-umzimba "uyazi" kangcono lapho futhi lapho udinga khona i-T3, futhi uma nje uhlinzeka nge-T4 ngokwanele uzokwenza umsebenzi ngokufanele. ngaphezu kwe-T4, "ukuqagela okwesibili" imizimba yomzimba.)
Kodwa-ke, kutholakale ubufakazi obuningi bokuthi, okungenani kwabanye abantu abane-hypothyroidism, ukuguqulwa okuphumelelayo kwe-T4 kuya ku-T3 kuntuleka. Ngamanye amazwi, naphezu kokuthi amazinga abo e-T4 angase abe ajwayelekile, amazinga abo e-T3 angase abe aphansi-ikakhulukazi kuma-tissue, lapho i-T3 empeleni isebenza khona.
Kungani ukuguqulwa kwe-T4 kuya ku-T3 kungahle kungabonakali kwabanye abantu, kulesi sikhathi, ikakhulukazi ukucatshangelwa-nakuba okungenani iqembu elilodwa leziguli liye laboniswa ngokuhlukahluka kofuzo (ku-diodinase 2 gene) okunciphisa ukuguqulwa kwe-T4 kuya ku-T3. Kunoma yikuphi, kubonakala sengathi odokotela kufanele baphathe okungenani abanye abantu abane-hypothyroidism nge-T4 no-T3.
Ukunikeza ukulinganisa okufanelekile kwe-T3 kuyinkimbinkimbi kunokuba ulandele ngokufanele i-T4. I-T4 ayisebenzi; uma unika kakhulu kunoma yimuphi umphumela osheshayo, oqondile wezingcuba (njengoba kufanele uguqulwe ku-T3 ngaphambi kokuba izicubu zithinteke). I-T3 yindaba ehlukile; yi -hormone ye-thyroid esebenzayo, ngakho-ke uma ubeka ngokweqile, ungaveza imiphumela ye- hyperthyroid ngokuqondile-ingozi, ngokwesibonelo, kubantu abanesifo senhliziyo.
Uma ungeza i-T3 kuya ku-T4 ngesikhathi ukwelashwa kwe-thyroid esikhundleni, ochwepheshe abaningi batusa ukuphatha isilinganiso se-T4: T3 phakathi kuka-13: 1 kuya ku-16: 1, okuyi-ratio ekhona kubantu abangenayo isifo se -roid. Lokhu kuyingxenye ephakeme ye-T4: T3 kunokuba isetshenzisiwe ezinhlolweni eziningi zomtholampilo.
Ukuhlolwa okungahleliwe okuqhathanisa imiphumela kanye ne-T4 yedwa ku-T4 + T3 ngokuvamile akubonanga inzuzo enkulu ekusebenziseni ukwelashwa okuhlangene kubantu abaningi abaneziguli ezine-hypothyroidism. Noma kunjalo, lezi zivivinyo aziklanyelwe ukuba zilandele ukuthi kungenzeka ukuthi izinzuzo zokwelashwa ezihlangene zikhawulelwe kwisigatshana esithile sabantu abane-hypothyroidism. Futhi naphezu kokuntuleka kobufakazi obunamandla bokuhlolwa komtholampilo, cishe zonke izazi manje ziyavuma ukuthi kunabantu abathile abane-hypothyroidism okufanele bathole kokubili i-T4 no-T3.
Ukwelapha i-Hypothyroidism: Indlela Eqondakalayo
Njengoba sinikwe ukuthi yini esikwaziyo mayelana ne-hypothyroidism, amazinga we-TSH, nobuhlobo phakathi kuka-T4 no-T3, ngokuba ochwepheshe abaningi indlela efanele yokuphathwa kwalesi simo kubonakala kanje:
Qala nge-"standard" indlela, usebenzisa imithi ye-T4 kuphela, ukuhlola ngokucophelela amazinga ka-TSH womabili kanye nezinga lokuphumula kwesifo, nokulungisa umthamo we-T4 ngokufanele. Kubantu abaningi, le ndlela izokusebenza kahle.
Uma izimpawu ze-hypothyroidism ziqhubeka naphezu kokufinyelela amazinga e-TSH ebangeni elijwayelekile elijwayelekile (okungukuthi, ngaphezu kwe-3 mIU / L kodwa ngaphansi kwe-5.0 mIU / L), noma ngabe kokubili izindlela ezimbili zokunye kufanele zibhekwe:
1) Ukwandisa umthamo we-T4 ngokwanele ukuze ususe izinga le-TSH libe ngaphansi kwe-3 mIU / L.
2) Engeza T3 emgomweni wokwelashwa, ngokuqapha okufanelekile.
Ngaphambi kokukhetha okunye okungu-2, ochwepheshe abaningi batusa ukulinganisa amazinga we-serum T3, futhi babhala ukuthi bahlala eduze komkhawulo ophansi webala lokubhekisela ejwayelekile, noma ngezansi. Uma amazinga we-T3 ephakathi kobubanzi obujwayelekile kuya phezulu, akungabazeki ukuthi ukungeza i-T3 emgomweni wokwelapha kuzokwenza ngcono izinto. ( Funda kabanzi mayelana nokulinganisa umsebenzi we-hormone yegciwane .)
Ngakho-ke: Uma uphathwa nge-hypothyroidism usebenzisa indlela "evamile" futhi izimpawu zakho azizange zinciphise kakhulu, udinga ukukhuluma nodokotela wakho mayelana nokucubungula eyodwa noma kokubili lezi zindlela ezihlukile.
Izwi elivela
Ukwelashwa kwe-hypothyroidism ngempela kunengqondo ngokuqondile, okungenani kuyi-theory. Futhi kubantu abaningi abanalesi simo, indlela eqondile, "indlela ejwayelekile" yokwelashwa isebenza kahle.
Kodwa uma indlela evamile ingazange ikhulise izimpawu zakho ze-hypothyroidism, sekuyisikhathi sokucabangela "indlela engezona ejwayelekile," indlela ehlukile-noma ukuqhubekela phambili amazinga e-TSH ngaphezulu ngaphansi kobubanzi obujwayelekile, noma ukufaka i-T3, noma kokubili.
> Imithombo:
> Escobar-Morreale HF, Botella-Carretero JI, u-Escobar del Rey F, et al. Ukubukezwa: Ukwelashwa kwe-Hypothyroidism Nezingxube Ze-Levothyroxine Plus Liothyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, uBauer AJ, et al. Imihlahlandlela yokwelashwa kwe-Hypothyroidism: Yilungiselelwe i-American Thyroid Association Task Force kwi-Thyroid Hormone Replacement. I-Thyroid 2014; 24: 1670.
> Panicker V, uSaravanan P, Vaidya B, et al. Ukuhluka Okuvamile ku-Genetic DIO2 Kubikezela Ukusekelwa Kwengqondo Nokuziphendulela Nokuziphendulela Kuhlanganiswa I-Thyroxine Plus Triiodothyronine Ukwelashwa kweziguli ze-Hypothyroid. J Clin Endocrinol Metab 2009; 94: 1623.