Mbiri Yopikisana Pa Matenda a Chithokomiro Chachilengedwe
Si chinsinsi chomwe chilengedwe cha mankhwala a chithokomiro (NDT) chakhala chikutsutsana kwazaka zambiri. NDT ndi mtundu wa mankhwala a chithokomiro chotchedwa thyroid, ndipo umatchedwanso chithokomiro chachilengedwe , chochotsera chithokomiro , chithokomiro cha porcine, "chithokomiro cha nkhumba," kapena mayina a mtundu monga Chilengedwe kapena Armor Thyroid.
NDT inayamba kumayambiriro kumayambiriro kwa zaka za m'ma 1900 ndipo imapangidwa kuchokera ku zozizira za zithokomiro zouma, monga njira yothandizira hypothyroidism, kusowa kwa mahomoni a chithokomiro.
Mitundu yoyambirira ya chithokomiro ya chilengedwe inachokera ku chithokomiro cha ng'ombe, koma kumayambiriro kwa zaka za m'ma 1900, kampani ya nyama yodyerako inalowa m'munda, kutulutsa chithokomiro chochokera ku nkhumba, chotchedwa Armor Thyroid.
Chifukwa chakuti idapangidwa pamaso pa FDA, malamulo ake monga mankhwala ovomerezeka anali atabadwa, ndipo chilengedwe chonyamulidwa, motsogoleredwa ndi FDA, sichinachitikepo ndi njira ya " New Drug Application " (NDA) yomwe inkafunika mankhwala atsopano adalengeza ku msika pambuyo pa FDA.
Chithokomiro chodziwika bwino chimakhala ndi T4 (thyroxine) ndi T3 (triiodothyronine), komanso calcitonin, ndi zinthu zina zomwe zimapezeka m'kamwa kake . Matenda a chithokomiro amatha kupanga makamaka T4 (hormone yosungirako) ndi zina T3, ndipo T4 imasanduka T3, hormone yogwira ntchito, kuti igwiritsidwe ntchito ndi maselo ndi ziphuphu za thupi.
Kukwera kwa Synthroid
Chakumapeto kwa zaka zapitazo, mankhwala opangidwa ndi chithokomiro amapangidwa pamsika.
Mpangidwe umenewu wa ma hormone T4 amadziwika kuti levothyroxine, ndipo nthawi zina amatchedwa dzina lachidziwitso, Synthroid. Levothyroxine anayamba kutchuka kwambiri, ndipo pakati pa theka lazaka za zana la makumi awiri ndi makumi awiri, idakhala chithandizo cha chisankho kwa anthu ambiri odwala.
Madokotala amati anali otetezeka komanso osasinthasintha kusiyana ndi chithokomiro chodziwika bwino, komanso kuti thupi linatha kusintha T4 kukhala yogwira ntchito T3 thupi lomwe liyenera kuthetsa hypothyroidism.
Kwa zaka makumi angapo, odwala chithokomiro ambiri anauzidwa mankhwala a levothyroxine kuti athandize hypothyroidism. Koma monga chidwi chinakula mu mankhwala achilengedwe m'zaka za m'ma 1980, madokotala ophatikizana komanso opambana adayambanso kutulutsa chithokomiro chokhazikika, chomwe chinakhalabe pamsika, ngakhale kuti chinali ndi gawo laling'ono la msika.
Madokotala ena omwe adagwiritsa ntchito chithokomiro choyambirira ndi odwala awo, adasinthira odwala kuti azitha kumwa mankhwala a chithokomiro Ena mwa odwalawa adadandaula, atasinthidwa ku levothyroxine, kuti zizindikiro zawo zakhala zikuipitsitsa kapena sizikanathetsedwa .
Ngakhale odwala ambiri a chithokomiro ndi madokotala sankadziwa kuti pali njira zina kunja kwa levothyroxine kuti apeze hypothyroidism, mu zaka za m'ma 1990, kuzindikira kuti NDT ndi njira yowonjezera, chifukwa cha zifukwa zingapo:
- kuwonjezeka kwa intaneti
- kuwonjezeka kwa odwala ena odwala
- kuwonjezereka kwa chidziwitso pakati pa odwala ndi odokotala
Odwala ambiri omwe ali ndi chithokomiro komanso osakhutira atatenga levothyroxine amadziwanso kuti mankhwala ochizira amachilombo amatha kukhala osiyana ndi levothyroxine.
Kugwiritsa ntchito mankhwalawa kunachulukira, ndipo odwala ena adapeza kuti zizindikiro zawo ndi magazi a chithokomiro , zimayendetsedwa bwino ndi chithokomiro chodziwika bwino, poyerekezera ndi levothyroxine, kapena levothyroxine komanso mawonekedwe a T3 (dzina lake ndi Cytomel, amadziwika kuti liothyronine.)
Mtsutso unakula pamene odwala adapempha chithandizo cha chilengedwe, ndipo ochiritsira ena, makamaka omwe ali ndi chidziwitso choonjezera, adayankha. Zambiri zabodza, ndi madokotala ena akulakwitsa kuti zachilengedwe zowononga mankhwala a chithokomiro zinalipo popanda mankhwala kapena zochokera ku ng'ombe, motero zinali zoopsa.
Malamulo okhudza chithandizo cha mankhwala adalimbikitsa levothyroxine ndipo adakhumudwitsa kwambiri kugwiritsa ntchito mankhwala osokoneza bongo.
Komabe, monga kulimbikitsidwa kwa oleza mtima ndi chidziwitso chinawonjezeka, ndipo monga mankhwala ochiritsira komanso ochiritsira ena omwe adakula kwambiri, chiwerengero cha mankhwala a chithokomiro chachilengedwe chinawonjezeka. Kafukufuku wofufuza za zachipatala, omwe anapanga chilengedwe cha mankhwala a chithokomiro Chilengedwe-chithokomiro ndi Westhroid (tsopano ndi WP Chithokomiro), chinagulidwa ndi RLC Labs, ndipo mankhwala awiriwa analandira gawo lalikulu la malonda.
Mauthenga atsopano a Clinical Practice Guidelines for Hypothyroidism mu Akuluakulu , olembedwa ndi American Association of Clinical Endocrinologists (AACE) ndi American Thyroid Association (ATA), chisonyezero chosadziwika cha chithokomiro. Zomwe zili ndi ndondomeko ya chitsogozo cha chithokomiro cha chilengedwe zimatchulidwa mwachidule m'nkhani ino, koma makamaka, iwo akupitiriza kunena molakwa kuti mankhwala a mankhwala a NDT anali ochokera ku ng'ombe, ndipo anayesera kutseka nkhaniyo ponena kuti "Palibe umboni wothandizira kugwiritsa ntchito chithokomiro hormone yokonda L-thyroxine monotherapy pochizira matenda a hypothyroidism ndipo motero kutulutsa mahomoni a chithokomiro sayenera kugwiritsidwa ntchito pochizira hypothyroidism. "
Iwo sankanena kuti palibe umboni woti muthandizire kugwiritsa ntchito levothyroxine mmalo mwa chithokomiro chochitidwa ndi chithokomiro. Kafukufukuyu sankapangidwira njira iliyonse, kotero, zaka za chizoloŵezi, chiphunzitso, ndi malonda zikuwoneka kuti ndizoziwongolera zomwe adalangizidwa, osati zofufuza kuchokera ku kafukufuku wofufuza kawiri kawiri, wamakono, wofalitsidwa ndi anzawo.
Kuyerekezera Levothyroxine ndi Chithokomiro Chodabwitsa
Kafukufuku waposachedwa, woposerapo, wokhala ndi chiphunzitso cha crossover anayerekezera chilengedwe chozizira chomwe chimatchedwa lavothyroxine. Kafukufukuyu anayeza odwala 70 (a zaka 18 mpaka 65) amene anali ndi hypothyroidism . Odwalawo anapatsidwa mwayi wokhala ndi chithokomiro kapena levothyroxine kwa masabata 16.
Pomaliza maphunzirowo, odwala anafunsidwa kuti apange chiani, ndipo pafupifupi 49 peresenti ankakonda kutentha kwa chilengedwe, pafupifupi 19 peresenti omwe ankakonda levothyroxine. Pafupifupi 33 peresenti sinafotokoze zomwe amakonda. Odwala omwe amatenga chithokomiro anataya pafupifupi mapaundi atatu, poyerekeza ndi odwala omwe amatenga levothyroxine , omwe sanateteze thupi.
Kafufuzidwe kameneka kanaperekedwa kwa a Endocrine Society ; odwala chithokomiro chachikulu komanso ofunikira. Odwala ndi odwala ali ndi ufulu kulongosola ndi kutenga mtundu uliwonse wa mankhwala a chithokomiro amadzimadzi ogwiritsira ntchito mankhwala a chithokomiro ogwira ntchito mosamala komanso abwino kwa wodwala aliyense.
Mawu ochokera
Ngati mukufuna kufufuza NDT ngati mankhwala anu hypothyroidism, kumbukirani:
- Mwina mungafunikire kugwira ntchito ndi dokotala wothandizira kapena wodalirika, wotsutsana ndi wodwalayo.
- Muyenera kumagwira ntchito ndi dokotala yemwe ali ndi luso lolemba ndondomeko ya NDT, ndikuyang'anira odwala pa NDT.
- Si nzeru kugula mankhwala osokoneza bongo pamtunda, popanda mankhwala, ndikuwatenga wopanda dokotala.
- Mankhwala othandizira pa chithokomiro osagwiritsira ntchito chithandizo cha chithokomiro si mankhwala a NDT, ndipo saloŵa m'malo mwa mankhwala a chithokomiro chothandizira mankhwala.
> Zotsatira:
> Hoang TD. "Zophatikizapo za chithokomiro zogwirizana ndi levothyroxine pochizira matenda a hypothyroidism." American Thyroid Association (March, 2013).