Ukwelashwa kwe-Thyroid ye-Hypothyroidism
Izindaba ezithokozisa iziguli ze-thyroid: isifundo eshicilelwe ephepheni elihlonishwayo futhi elihlonishwayo ekupheleni kwe-endocrinology lithi ukuhlanganiswa kwe-T4 / T3 kuphakeme kunokwelashwa kwe-T4 kuphela / levothyroxine ye-hypothyroidism! Nazi imininingwane.
Ucwaningo lwe-groundbreaking olubikwe kwi- European Journal of Endocrinology lubukisisa inkinga yokuphikisana enokwenziwa nge-synthetic T3 njengengxenye yokwelashwa kwe-T4-kuphela (levothyroxine) yokwelashwa kwe-hypothyroidism.
Ezinye izifundo ezibuyela emuva eminyakeni engaphezu kweyishumi zibonise ukuphakama komuthi wokuhlanganiswa. Ezinye izifundo, noma kunjalo, azitholanga umehluko. Ukungahambisani kwalezi ziphumo zosesho ku-T3 kuye kwaholela ochwepheshe abathile - ikakhulukazi, labo abathandana nabo ngenxa ye-levothyroxine-kuphela yokwelapha - ukuphetha ngokuthi ayikho inzuzo ekwengezeni i-T3. (Abanye kulabo "ochwepheshe" abanjalo benza ngisho nokuqamba okukhulu, futhi baphetha ngokungafanele ukuthi i-levothyroxine / iT4-kuphela yokwelapha iphakeme kune-T4 / T3 yokwelapha.)
Kunoma yikuphi, ekucwaningweni, abacwaningi baseDenmark benza ucwaningo oluphindaphindiwe-oluyimpumputhe, olungenangqondo - olubhekwa njengefomethi ejwayelekile yegolide yokucwaninga - kweziguli ezingama-59. Esigabeni sesiguli, ama-microgram angu-50 we-dose evamile ye-T4 athathe indawo engama-20 mcg we-T3 noma ama-50 mcg we-T4 amasonto angu-12. Iziguli zenza "ukuwela," ukwenza okuphambene namanye amasonto angu-12.
Umthamo we-T4 wawulawulwa uma kudingekile ukugcina amazinga e-TSH azinzile.
Izivivinyo zekhwalithi yokuphila (i-QOL) nokucindezeleka kwenziwa ekuqaleni, futhi emva kokubili ukwelashwa kwamasonto angu-12. Ikhwalithi yokuphila nezici zengqondo ezihlolwe zifakiwe, phakathi kwezinye izici: impilo ejwayelekile, ukusebenza komphakathi, impilo yengqondo, ubungqabavu, ukuzwela, ukucindezeleka nokukhathazeka.
Lokho abacwaningi abathola ukuthi phakathi kweziguli - abangu-55 kubo babengabesifazane - kwakukhona umehluko omkhulu phakathi kwezingu-7 kwezingu-11 ze-QOL nezikole zokucindezeleka, okubonisa umphumela omuhle ohlobene nokutheleleka kwe-T4 / T3 inhlanganisela.
Ingqikithi yezingu-49% zeziguli zikhethe ukwelashwa kokuhlanganiswa, futhi kuphela u-15% okhethwe ukwelashwa kuphela kwe-levothyroxine.
Abacwaningi baphetha ngokuthi, ocwaningweni lapho amazinga e-TSH agcinwa ahlale ehambisana khona, ukwelapha okuhlanganiswa kwe-T4 / T3 okubandakanya i-20 mcg ye-T3 nsuku zonke kwakungcono ukwelashwa kuphela kwe-levothyroxine, uma uhlola izinga lempilo yokuphila, ukucindezeleka nokukhathazeka izikali, nokuthandwa kwesineke.
Odokotela bavame ukubeka ingozi yemiphumela emibi nge-T3 yokwelashwa njengesisusa sokungasebenzisi i-T3, kodwa lolu cwaningo lubonise ukuthi kwakungekho umehluko mayelana nemiphumela emibi. Ngokusho kwabalobi, ngesikhathi kusetshenziselwa ukwelashwa kwe-T4 / T3, abantu abahlanu babhekana nemiphumela emibi ehlanganisa izidakamizwa, ukujuluka ngokweqile, nokungazinzi ngokwengqondo. Ngesikhathi ukwelashwa kwe-T4 kuphela, abantu abayisishiyagalolunye babika imiphumela emibi efanayo.
Kuyathakazelisa ukuthi abacwaningi baseDenmark babonisa izinkinga ngezinye zezifundo zangaphambilini ze-T4 / T3 zokwelashwa ezingazange zithole inzuzo ku-T3 yokwelapha, ethi: "izifundo ezifakwe ekuhlaziyweni kwe-meta zaziyingxube yamaqembu ahlukene eziguli, kuhlanganise neziguli nomdlavuza wegciwane wangaphambilini, i-autoimmune hypothyroidism, ne-subclinical kanye ne-overt hypothyroidism. "
Futhi, ngokusho kwabacwaningi baseDenmark, kwesinye sezifundo eziyinhloko, "... [abalobi] abakwazi ukugcina amazinga we-TSH e-serum ezingeni elifanayo kumaqembu amabili wokwelapha, i-serum ye-TSH ibe ngu-3 eqenjini elihlanganisiwe futhi 1.5 mU / l eqenjini le-monotherapy.
Abacwaningi bathi ukutadisha kwabo kusikisela ukuthi iqembu elincane leziguli libonakala lizuzwa ekuthathweni kwe-T4 / T3 ehlangene. Ngokuyinhloko, basikisela ukuthi kungase kube nezizathu ze-physiologic ukuthi kungani i-subgroup isabela - noma izidingo - i-T3, ngokukhethekile, ukuthi:
... i-polymorphism esanda kutholakala kuleso geni ekhokhwa ngohlobo lwe-deiodinase, i-enzyme ephathekayo yokulawulwa kwe-T3 ukutholakala nezicubu, iye yahlongozwa ukuze kusize ukuhlukanisa ama-subgroups amathuba okuthola usizo lwe-T4 / T3. Enye i-polymorphism, etholakala ku-OATP1C1, i-hormone ye-hormone ye-thyroid eyaboniswa ekuvinjeni kwegazi, ihlotshaniswe nokukhathala nokucindezeleka.
I-endocrinologist yaseDutch i-Wilmar Wiersinga ithi i-Sustainable Release T3 ingaba ingcono kakhulu, abanye abantu bangase babe ne-Genetic Propensity ukuze benze ngcono ku-T3
Udokotela wezidakamizwa waseDutch uWilmar Wiersinga wabhala i-editorial ehambisana nalesi sihloko esithi, "Ingabe sidinga izilingo ezingaphezu kuka-T4 no-T3 ukwelashwa kokuhlanganiswa ku-hypothyroidism?"
Ngokusho kukaDkt. Wiersinga, ezinye izifundo zangaphambilini zaphetha ngokuthi ayikho inzuzo yokwengeza i-T3. Noma kunjalo, iqiniso lokuthi, ngokwe-Wiersinga, iziguli ezingu-10% ze-hypothyroid azigculisisi ngokuthi bazizwa kanjani kulokho odokotela abazobiza ngokuthi "umthamo okwanele" we-levothyroxine esikhundleni sokuholela ekufundisweni kwesiDanish.
Umhleli, oshicilelwa ngokugcwele ku-intanethi, ukhomba amaphutha emiphakathini yangaphambilini kanye nokuhlaziywa kwe-T4 / T3 yokwelashwa kokuhlanganiswa. UDkt. Wiersinga uphetha ngokuthi kunezizathu ezimbili eziqinile zokuqhuba ukuhlolwa okulinganiselwe okungahleliwe okuqhathaniswa ne-levothyroxine / T4 yokwelapha kuphela i-monotherapy, ku-T4 / T3 yokwelashwa okuhlangene:
Okokuqala, izilingo kuze kube manje azizange ziphumelele ukulinganisa izibalo ze-serum FT4-FT3 kuwo wonke amahora angu-24. Ukuthuthukiswa kokulungiswa okuqhubekayo kwe-T3 kungase kudingeke ukuba kufinyelele umgomo we-'mveloological 'we-hormone ye-thyroid. Okwesibili, inani elikhulayo lama-polymorphisms kuma-deiodinase kanye nabathungisi be-hormone be-thyroid bahlotshaniswa nenhlalakahle yengqondo, ukucindezeleka, ukukhathala, nokuthandwa kwe-combination combination. Kungenzeka yini ukuthi izifundo ezinganelisekile nge-monotherapy ziyizinkampani ezivame ukuzenza lezi polymorphisms, futhi ziyoba nesiphezulu esingcono kumuthi wokwelapha?
Ngokusho kukaDkt. Wiersinga, ukuthuthukiswa kokulungiswa okuqhubekayo kwe-T3, okuhlinzekwa njengomthamo owodwa wokulala ebusuku (kanye ne-levothyroxine kanye nsuku zonke) kungase kulungele kahle ukulingana kwemvelo ye-Free T4 ne-Free T3 kwezinye iziguli ze -roid esikhathini esingamahora angu-24.
Qaphela: Ngakho ake sibuyele kabusha lokhu. Isiqingatha seziguli zithande inhlanganisela ye-T4 / T3 - kuphela u-15% okhethwe i-levothyroxine kuphela, futhi, izinga lokuphila nezinye izici zathuthukisiwe. Futhi, ukwelashwa kwe-T4 / T3 kwakungekho nemiphumela emibi ngaphezu kwe-T4-yedwa. (Eqinisweni, kulolu cwaningo, ukwelapha kuphela kwe-T4 kwabangele imiphumela engaphezulu yemiphumela.) Ngilindele ukuthi ezinye zezinto ezibizwa ngokuthi izazi ze-teyroid - ezivame ukukhokha abakhiqizi be-levothyroxine - mhlawumbe ziya baziwa bezama ukuchaza lokho okutholakele, futhi kuzobajabulisa ukubabheka bezama!
I-athikili yangempela yephephabhuku ufunda ngokuthakazelisayo, kodwa ngeshwa, ayithunyelwe kwi-Inthanethi ngokugcwele. Kodwa-ke, ungathenga ikhophi ku-intanethi nge $ 25 kwiwebhusayithi ye-European Journal of Endocrinology . Lokhu nakanjani ofuna ukuthi udokotela wakho afunde, ngakho-ke qiniseka ukuthi umtshele ukuthi athole ikhophi. Ngokweqiniso, kungase kudingeke ngisho ukuthenga ikhophi UKUBA kudokotela wakho, uma engathandi ukufunda ngezinyathelo ze -roid.
Ulwazi olwengeziwe ku-T4-kuphela Vs. T4 / T3 Ukwelapha Ukuhlanganiswa kwe-Hypothyroidism
- Ukubheka i-T4 kuphela ngokuphikisana no-T4 / T3 I-Drug Controversy
- I-T3 I-Triiodothyronine Izidakamizwa Zithuthukisa I-Quality of Life ye-Hypothyroidism: Ucwaningo Luthola Iningi Lamagciwane Ukuzwa Okungcono Nge-Add T3 / New England Journal of Medicine Study of 1999
- Isifundo Sithola Iziguli Zithatha Inhlanganisela T4 / T3 Ukwelashwa: Imibukiso Yokucwaninga I-Combo Therapy Ehlanganiswe Nokushukela Kwesisindo / 2005
> Imithombo:
> UBirte Nygaard, u-Ebbe Winther Jensen, uJan Kvetny, u-Anne Jarløv noJens Faber. "Umthelela We-Combination Therapy nge Thyroxine (T4) no-3,5,3'-Triiodothyronine Versus T4 Monotherapy ezigulini ezine-Hypothyroidism, i-Double-Blind, i-Randomized Cross-Over Study," i- European Journal of Endocrinology , Vol 161, Issue 6, 895-902, Disemba 2009 Abstract, (Umbhalo ogcwele ($ 25))
> Wiersinga, Wilmar "Ingabe Sidinga Izivivinyo Ezingaphezu Kwezi-T4 no-T3 Ukwelashwa Kokuhlanganiswa ku-Hypothyroidism?" I-European Journal of Endocrinology , Vol 161, Issue 6, 955-959. Umbhalo ogcwele (mahhala)