Hypothyroidism (chithokomiro chopanda mphamvu) ndi matenda aakulu omwe angakhudze thanzi lanu. Kuphatikizirapo kumayambitsa mavuto ambiri (kuphatikizapo kupweteka , tsitsi ndi kusintha kwa khungu, kudzimbidwa kapena kutsegula m'mimba, kusabereka, kutopa, ndi kupweteka), hypothyroidism ingakhalenso ndi mavuto aakulu azachipatala omwe amachititsa mtima ndi mapapo, matenda a m'mimba, dongosolo lamanjenje, maso, ndi minofu.
Kuonjezera apo, izo zingayambitse kusintha kosiyanasiyana kwa thupi kuphatikizapo hyponatremia (otsika seramu ya ndondomeko yamchere), mpweya wa mafuta m'thupi , komanso kuwonjezeka kwa serum creatinine (ntchito ya impso). Kuchuluka kwa hypothyroidism kungayambitsenso kusinthika kwa chidziwitso, kukomoka, ndi imfa.
Ngati muli ndi hypothyroidism, nkofunika kuti inu ndi dokotala musamalire bwino matendawa kuti muchotse zizindikiro zanu, komanso kuchepetsa ndi kupewa matendawa.
Kodi Cholinga cha Chithandizo N'chiyani?
Zolinga zothandizira ma hypothyroidism n'zosavuta. Ali:
- kuonetsetsa kuti mahomoni a chithokomiro amadziwika bwino (makamaka, ma T4, T3 ndi TSH)
- kuthetsa zizindikiro za hypothyroidism
- kuima ndi kusinthira zotsatira za hypothyroidism zikhoza kukhala ndi zamoyo zosiyanasiyana
- ngati pali goiter (monga nthawi zina ndi matenda a Hashimoto , mwachitsanzo), kuchepetsa kukula kwake
Kodi Chithandizochi Chakwaniritsidwa Bwanji?
Papepala, mankhwala a hypothyroidism ndi abwino kwambiri.
Amapatsidwa mankhwala opanga mavitamini a chithokomiro (kawirikawiri levothyroxine, ogulitsidwa monga Synthroid , kukonzekera T4), ya mlingo wokwanira kubwezeretsa mahomoni ambiri a chithokomiro, popanda kutulutsa poizoni kuchokera ku hormone yambiri ya chithokomiro.
Komabe, pakuchita chithandizo chabwino kwambiri cha hypothyroidism kwachititsa kuti pakhale kusiyana kwakukulu.
Mfundo zazikuluzikulu ndi ziwiri:
- Kodi ndiwe wotsikitsitsa bwanji ukasakaniza ma tishoni musanayambe kuganiza kuti hypothyroidism ndizoyenera kuchiritsidwa bwino?
- Kodi kutenga T4 kungokwanira, kapena kodi T3 iyeneranso kulamulidwa?
(Pofuna kusunga mahomoni a chithokomiro molunjika, werengani mwamsanga mwatsatanetsatane wa chithokomiro, T4, T3, ndi TSH .)
Tidzakambirana mafunso awiri onsewa titatha kuyang'ana "mankhwala" omwe amagwiritsidwa ntchito podziteteza ku hypothyroidism.
Matenda a 'Standard' a Hypothyroidism
Endocrinologists (akatswiri odwala matenda a mahomoni) pafupifupi padziko lonse amalangiza kuti azichiritsa matenda a hypothyroidism ndi T4 okha. Madokotala aang'ono, omwe ali ndi thanzi labwino amayamba ndi zomwe zimawoneka kuti ndi "mankhwala okwanira" a T4 (ndiko kuti, mlingo womwe umayenera kubwezeretseratu chithokomiro moyenera). Mlingo wokwanira wogwiritsira ntchito mankhwalawa umayesedwa malinga ndi kulemera kwa thupi, pafupifupi 1.6 mcg pa makilogalamu. Kwa anthu ambiri izi zidzakhala pakati pa 50 ndi 200 mcg pa tsiku.
Kwa anthu achikulire kapena anthu omwe ali ndi matenda a mitsempha , chiyambi cha chithandizo cha chithokomiro chimayendetsedwa pang'onopang'ono; kuyambira ndi 25-50 mcg tsiku ndi tsiku, ndikuwonjezera mlingo pa nthawi.
Anthu ayenera kutenga T4 pamimba yopanda kanthu, mwinamwake kuyamwa kwa mankhwala kumakhala kovuta.
Kawirikawiri, madokotala amalimbikitsa kumwa mankhwalawa tsiku loyamba, ndikudikirira ola limodzi kuti adye chakudya cham'mawa (kapena kumwa khofi). Kutenga mankhwala pa nthawi yogona, maola angapo mutatha kudya komaliza, kumawoneka kuti akugwira ntchito, ndipo ukhoza kukhala njira yabwino kwambiri kwa anthu ambiri. Werengani zambiri za nthawi yomwe mumamwa mankhwala a chithokomiro .
Maseŵera a TSH akuyang'aniridwa kuti athandize kuchulukitsa mlingo wa T4. TSH-chithokomiro cholimbikitsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa mahomoni. Choncho, pamene mahomoni a chithokomiro ali otsika (monga hypothyroidism), mazinga a TSH amachitapo kanthu, poyesera "kukwapula" mahomoni ambiri a chithokomiro kuchokera ku chithokomiro cha chithokomiro.
Pamene hypothyroidism imachiritsidwa mokwanira, miyeso ya TSH imabwereranso pansi. Choncho, chofunika kwambiri pakuzindikira mlingo wabwino wa T4 ndi kuyesa miyeso ya TSH .
Ngakhale kuti zizindikiro za hypothyroidism zimayamba kuthetsa pakapita masabata awiri kuti ayambe kulandira chithandizo, zimatenga pafupifupi masabata asanu ndi limodzi kuti magulu a TSH akhale otsika. Choncho, magulu a TSH amawerengedwa masabata asanu ndi limodzi mutatha mankhwala. Ngati miyeso ya TSH imakhalabe pamwamba pa zolingazo, mlingo wa T4 wochulukitsidwa ndi 12-25 mcg pa tsiku, ndipo ma seti a TSH amabwerezedwa pakatha masabata asanu ndi limodzi. Njirayi imapitilizidwa mpaka mlingo wa TSH ukufika pamtundu woyenera, ndipo zizindikiro zatsimikiziridwa. Pomwe mlingo woyenera wa T4 wakhazikitsidwa, mazinga a TSH amawerengedwa chaka chilichonse kapena pambuyo pake, kuti atsimikizire kuti chithandizocho chimakhala chosakanizidwa.
Pali mitundu yosiyanasiyana ya T4 yopangidwa ndi opanga osiyana. Ngakhale kuti machitidwe onse a FDA amavomerezedwa kuti ndi oyenerera, akatswiri ambiri amalimbikitsa kuti azigwiritsanso ntchito zomwezo, osasintha, chifukwa momwe zilili zofanana zimasiyana mosiyana pakati pa zochitika zosiyanasiyana.
Izi, ndiye, ndi njira yoyenera yochizira matenda a hypothyroidism, ndipo kachiwiri, ndizosavuta. Zikuwoneka kuti zimagwira ntchito kwa anthu ambiri; ndiko kuti, njira yothandizira imeneyi imabweretsa chisamaliro cha zizindikiro ndi kubwezeretsedwa kwa maselo otentha a chithokomiro mwa anthu ambiri omwe ali ndi hypothyroidism.
Koma osati mwa onse. Ndipo apa ndi pamene mikangano imabwera.
Kutsutsana: Kodi Cholinga Choyenera cha TSH N'chiyani?
Monga taonera, kuyesera ma tshoni ndizofunikira kwambiri poyesa kulandira chithandizo cha chithokomiro chokwanira.
Koma si aliyense amene amavomereza kuti "zachilendo" ndi mazinga a TSH . Mitundu yayikulu yambiri ya mapopokineti imakhala yosiyana kwambiri pakati pa 0,5-4.5 (kapena ngakhale 5.0) mIU / L. Komabe, gulu lalikulu la otsutsa (American Association of Clinical Endocrinologists) linanena kuti pamwamba pazomwe ziyenera kukhazikitsidwa ayenera kuchepetsedwa kukhala 3.0 mIU / L. Anthu omwe mazinga a TSH ali apamwamba kuposa apamwamba kwambiri, adanena, akhoza kukhala hypothyroid.
Funsoli ndi lofunika pa zifukwa zingapo, koma (monga momwe tawonera) imodzi mwa izo ndi yakuti, pamene mukuchiza hypothyroidism, nkofunika kudziŵa ngati chiwerengero cha TSH pakakhala mankhwala akuchilendo, kapena ayi. Ngati mlingo wanu wamtundu wa TSH uli ndi 4.2 mIU / L, malingana ndi ambiri omwe amapita ku matenda a endocrine amachiritsidwa bwino; koma molingana ndi anthu ochepa kwambiri mumafunikira mlingo wapamwamba wa mahomoni a chithokomiro.
Choncho, kutsutsana kumeneku kumapangitsa kuti mankhwala a hypothyroidism akhale ovuta.
Mtsutso: Kodi T4 yokha ndi Yokwanira Kapena T3 Iyenera Kuperekedwa?
T4 ndiyo yaikulu yomwe imayambitsa mahomoni a chithokomiro, koma si homoni yogwira ntchito. T4 imasandulika kukhala T3 m'magulu, monga pakufunikira. Ndipo T3 ndi hormone ya chithokomiro yomwe imagwira ntchito yonse. (T4 ndi "chabe" prohormone-malo osungirako T3, njira yotsimikizirika kuti T3 ikhoza kupangidwa pa mphindi imodzi ndi miniti ngati pakufunika.)
Tikamapatsa T4 osati T3, "timadalira" matenda a munthu amene ali ndi hypothyroidism kutembenuza kuchuluka kwa T4 mpaka T3, pamalo abwino, komanso pa nthawi yoyenera. (Ndipotu izi ndizofunikira kwambiri kuti azimayi azigwiritsa ntchito T4 okha - thupi limadziwa bwino lomwe ndi liti pamene likufunikira T3, ndipo malinga ndi momwe mungaperekere ndi T4 mokwanira, idzagwira ntchito bwino. kuwonjezerapo ndi T4, iwo "amalingalira kachiwiri" thupi laumwini.)
Komabe, pali umboni wochuluka wosonyeza kuti, mwa anthu ena omwe ali ndi hypothyroidism, kutembenuzidwa koyenera kwa T4 mpaka T3 kulibe. Mwa kuyankhula kwina, ngakhale kuti ma t4 awo akhoza kukhala abwino, magulu awo a T3 angakhale otsika-makamaka m'magulu, kumene T3 kwenikweni amachita ntchito yake.
Chifukwa chake T4 kutembenuka kwa T3 kungakhale kosazolowereka kwa anthu ena, pakadali pano, makamaka kuganiza-ngakhale gulu limodzi la odwala ladziwika ndi mitundu yosiyana siyana (mu dijinase 2 gene) yomwe imachepetsa kutembenuka kwa T4 mpaka T3. Mulimonsemo, zikuwoneka kuti madokotala ayenera kuthandiza anthu ena omwe ali ndi hypothyroidism ndi T4 ndi T3.
Kupereka mlingo woyenera wa T3 ndi wolemetsa kuposa momwe mungayankhire bwino T4. T4 sakugwira ntchito; Ngati mupereka mochuluka, palibe mankhwala amodzi (omwe ayenera kutembenuzidwira ku T3 musanatengedwe). T3 ndi nkhani yosiyana; ndi mankhwala otentha a chithokomiro, kotero ngati mupereka mochuluka, mukhoza kupanga zotsatira za hyperthyroid mwachindunji-chiopsezo, mwachitsanzo, kwa anthu omwe ali ndi matenda a mtima.
Powonjezera T3 mpaka T4 panthawi ya chithandizo cha chithokomiro, akatswiri ambiri amalimbikitsa kupereka chiŵerengero cha T4: T3 pakati pa 13: 1 mpaka 16: 1, yomwe ndi chiŵerengero chomwe chiripo mwa anthu opanda matenda a chithokomiro. Ichi ndi chiwerengero chapamwamba cha T4: T3 kuposa momwe amagwiritsidwira ntchito m'mayesero ambiri omwe amapezeka m'midzi.
Mayesero a randomzedwe kuyerekezera zotsatira ndi T4 yekha ku T4 + T3 ambiri sanawonetsere phindu lalikulu pogwiritsira ntchito mankhwala othandizira anthu ambiri omwe ali ndi hypothyroidism. Komabe, mayeserowa sankapangidwira kuti mwina phindu la mankhwala ophatikizana likhoza kukhala lochepa kwa anthu ena omwe ali ndi hypothyroidism. Ndipo ngakhale kuti alibe umboni wolimba wa zachipatala, pafupifupi akatswiri onse akuvomereza kuti pali anthu ena omwe ali ndi hypothyroidism omwe ayenera kulandira T4 ndi T3.
Kuchiza Hypothyroidism: Njira Yokwanira
Tapatsidwa zomwe timadziŵa zokhudza hypothyroidism, mazinga a TSH, ndi mgwirizano pakati pa T4 ndi T3, chifukwa akatswiri ambiri ali ndi njira yabwino yothetsera vutoli zikuwoneka ngati izi:
Yambani ndi njira "yoyenera", pogwiritsira ntchito mankhwala a T4 okha, kuyesa mosamala mazinga onse a TSH ndi msinkhu wa kupuma kwa chizindikiro, ndi kusintha mlingo wa T4 molingana. Kwa anthu ambiri, njirayi idzagwira ntchito bwino.
Ngati zizindikiro za hypothyroidism zikupitirirabe ngakhale kuti ma TSH akukwera bwino kwambiri (omwe ali pamwamba pa 3 mIU / L koma pansi pa 5.0 mIU / L), ndiye njira ziwiri kapena ziwiri ziyenera kuganiziridwa:
1) Kuchulukitsa mlingo wa T4 mokwanira kukankhira mlingo wa TSH pansi pa 3 mIU / L.
2) Onjezerani T3 kumayendedwe ochizira, ndi zofunikira zoyenera.
Asanasankhe 2 ena, akatswiri ambiri amalimbikitsa kuyesa maselo a T3 a seramu, ndikulemba kuti amakhala pafupi ndi mapeto otchulidwa, kapena pansipa. Ngati ma T3 ali m'katikati, ndizosakayika kuti kuwonjezeranso T3 ku chithandizo cha mankhwala kudzakonza zinthu. ( Werengani zambiri zokhudza kuyesa mahomoni a chithokomiro .)
Choncho: Ngati mukupatsidwa chithandizo cha hypothyroidism pogwiritsira ntchito "njira" ndipo zizindikiro zanu sizinachepetsedwe kwambiri, muyenera kuyankhula ndi dokotala wanu poganizira njira imodzi kapena zonsezi.
Mawu Ochokera
Mankhwala a hypothyroidism ndi ofunika kwambiri, mozama. Ndipo mwa anthu ambiri omwe ali ndi vutoli, njira yowongoka, "yoyenera" njira yothandizira imathandiza kwambiri.
Koma ngati chizoloŵezicho sichikuchotsani zizindikiro za hypothyroidism, ndi nthawi yoganizira "osagwirizana," njira zowonjezera-mwina kukakamiza TSH maulendo kupitirira pansi mkati mwake, kapena kuwonjezera T3, kapena onse awiri.
> Zotsatira:
> Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. KUYAMBIRANA: Kuchiza kwa Hypothyroidism Ndi Kuphatikiza kwa Levothyroxine Plus Liothyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, Bauer AJ, et al. Malangizo a Chithandizo cha Hypothyroidism: Wokonzedwa ndi American Thyroid Association Task Force pa Kutentha Hormone m'malo. Chithokomiro 2014; 24: 1670.
> Panicker V, Saravanan P, Vaidya B, et al. Kusiyanasiyana kwadongosolo mu DIO2 Gene Kumalongosola Baseline Zamoyo Zaumoyo ndi Kuyankha kwa Mgwirizano Thyroxine Plus Triiodothyronine Mankhwala mu odwala a Hyperothyroid. J Clin Endocrinol Metab 2009; 94: 1623.