Kwa zaka zoposa 40, njira yodalirika yochizira matenda a hypothyroidism yakhala ikuthandizani kutulutsa mankhwala otchedwa levothyroxine (ie, Synthroid, Levoxyl); ndi cholinga choonetsetsa kuti mlingo wa TSH uli mkati mwawotchulidwa. Izi zakhala zikuwonedwa kuti ndi mankhwala oyenera a chikhalidwe.
Chiphunzitso cha njirayi yowonongeka ndi yakuti mankhwala a levothyroxine-mawonekedwe a thyroxine (T4) mahomoni opangidwa ndi chithokomiro-adzakupatsani zokwanira T4, kubwezeretsa ku chithokomiro chodziwika bwino-chotchedwa euthyroidism-ndi kuthetsa chithokomiro chonse- zizindikiro zokhudzana nazo.
Otsogola ambiri, kuphatikizapo wotchuka wotchedwa endocrinologist Dr. Anthony Weetman , adanenanso kuti odwala omwe ali ndi "zowonongeka kachitidwe ka chithokomiro" koma amaumirira kuti ayenera kuchiritsidwa ndi zizindikiro zambiri za chithokomiro kapena amene ali ndi zizindikiro zimakhala ndi "somatoform disorders." (Matenda a Somatoform amafotokozedwa m'mawu otanthauzira azachipatala monga "matenda okhudza maganizo omwe amalembedwa ndi zodandaula zakuthupi, zomwe palibe chidziwitso chakuthupi kapena chilengedwe chomwe chimapezeka ndi chomwe chiri chotheka kwambiri kuti zifukwa zimagwirira ntchito.")
Chithokomiro chodziwika bwino chimatulutsa mahomoni ambiri, kuphatikizapo hormone yosungirako thyroxine (T4) ndi hormone yogwira triiodothyronine (T3). Mahomoni ambiri opangidwa ndi gland ndi T4, koma T4 ayenera kutembenuzidwa m'thupi kuti ikhale ndi ma hormone yogwira ntchito kuti ikhale ndi mphamvu m'thupi lanu. Nthano yamphamvu ndi yodalirika ndi yakuti hypothyroidism iyenera kuchitidwa kokha ndi levothyroxine-nthawizina imatchedwa LT4 monotherapy kapena levothyroxine monotherapy-pa mlingo womwe umapangitsa kuti mukhale euthyroid, ndi ma tshoni anu a TSH omwe akugwera muzokambirana.
Nthano iyi imanena kuti pali T4 yokwanira, thupi lidzachita nthawi zonse T3.
Ngakhale kuti chikhulupilirochi ndichichikulu mwa mankhwala ochiritsira, kwa zaka makumi angapo odwala chithokomiro amayamba kulimbikitsidwa kwambiri ndi vuto la levothyroxine pothetsa zizindikiro zawo. Ochita kafukufuku amaonetsetsa kuti odwala 15 peresenti akupitirizabe kukumana ndi mavuto odwala hypothyroidism ngakhale kuti mankhwalawa ndi a levothyroxine.
Kafukufuku wa odwala chithokomiro amasonyeza kuti chiwerengerocho n'chokwanira kwambiri .
Zotsatira Zofufuza
Kufufuza ngati kubwezeretsa chiwerengero cha TSH kumalo otchulidwa pogwiritsa ntchito levothyroxine kunali kothandiza, ofufuza a Rush University Medical Center ku Chicago anachita kafukufuku poyerekeza gulu lolamulira la anthu omwe ali ndi thanzi labwino, opanda umboni wa matenda a chithokomiro, motsutsana ndi gulu la anthu omwe anali kuchiritsidwa ndi levothyroxine kwa hypothyroidism. Zotsatirazo zinafotokozedwa mu magazini ya October 2016 a Journal of Clinical Endocrinology ndi Metabolism .
Zotsatirazo zinali zodabwitsa kwambiri. Kafukufukuyu anapeza kuti:
- Gulu la mankhwalawa la levothyroxine linali ndi ma levelsi a TSH okwana 20 peresenti, 10 peresenti ya pansi pa T3 masewera, ndi 15% poyerekeza ndi T3 poyerekeza ndi gulu lolamulira.
- Gulu la mankhwalawa la levothyroxine linali ndi chiwerengero cha thupi lapamwamba kwambiri, ngakhale kuti iwo ankadziwa kuti amadya zakudya zochepa patsiku. Ankalemera pafupifupi mapaundi 10, ngakhale kuti ankamwa makilogalamu pang'ono patsiku.
- Gulu la mankhwala a levothyroxine linali ndifupipafupi 1.6 kuchulukitsa beta-blockers, yomwe nthawi zambiri imagwiritsidwa ntchito pofuna kuchiza magazi.
- Gulu la mankhwalawa la levothyroxine linali 1.5 nthawi zambiri kuti atenge mankhwala osokoneza bongo, omwe ankagwiritsidwa ntchito pochiza mafuta m'thupi.
- Gulu la mankhwala a levothyroxine linali ndi nthawi 1,46 zomwe zimakhala zovuta kwambiri kuti munthu adwale matenda opatsirana.
- Gulu la mankhwala a levothyroxine linanena kuti sali ochepa kwambiri thupi kusiyana ndi gulu lolamulira.
- Gulu la mankhwala a levothyroxine adadziwonetsera masiku ambiri mwezi watha kumene adamva kuti thupi lawo ndi thanzi lawo silinali bwino.
Zolemba
Ofufuzawa adanena kuti ali ndi zifukwa ziŵiri-ngakhale kuti ali euthyroid ndi ma TSH m'magulu otchulidwa-gulu la mankhwala la levothyroxine silinali labwino monga momwe limawerengedwera ndi magawo angapo, ndipo chifukwa chiyani levothyroxine adanena kuti Timamva bwino kwambiri kuposa gulu lolamulira.
- Nthano imodzi ndi yakuti ngakhale kuti TSH yayamba, mlingo wa T3-hormone yogwira ntchito-ikhoza kusamveka bwino, chifukwa T4 sikutembenuza T3 mokwanira.
- Phunziro lachiwiri likusonyeza kuti ma T3 omwe amafika pamaselo sangathe kuwonetsedwa ndi magulu a TSH kapena T4 a magazi, chifukwa cha zochita za ma deiodinases, zomwe zimawathandiza kusintha T4-to-T3.
Ofufuzawo anamaliza nkhaniyi m'nkhaniyi ndi mawu akuti:
Lingaliro lakuti kukhazikitsa kachilombo ka HIV kameneka kumapangitsa anthu pa (levothyroxine) monotherapy clinically euthyroid ayenera kubwereranso ndipo khalidwe labwino liyenera kukhala lofunika kwambiri pa kafukufuku wa hypothyroidism ndi malangizo othandizira.
Mfundo Yowonjezera Yophunzira Wolemba Antonio Bianco, MD
Wolemba mabuku wina, Antonio Bianco, MD, pulezidenti wakale wapamodzi wa American Thyroid Association, ndi pulofesa ku Rush University, adapempha mafunso ku MedicalResearch.com. Pomwe anafunsa mafunsowa, adafotokozera kuti:
Phunziro lachidziwitso likuwonetsa kuti kuika kwa maselo a TSH mu odwala hypothyroid sikungakhale kofunikira monga momwe ankaganizira kuti akuyang'anira chithandizo. Ngakhale odwala TSH amakhala ovuta, odwala ali ndi chiopsezo chachikulu kwambiri chokhala ndi vuto la kuvutika maganizo komanso kuwonongeka kwa thupi kosadziwika bwino komwe kumawoneka ndi kulemera kwa thupi komanso kuchuluka kwa mafuta m'thupi. Takhala tikukunena kuti mwa kuika magazi magazi a TSH zizindikiro zonse zogwirizana ndi hypothyroidism ziyenera kuchoka . Izi ziyenera kusintha.
Pamsindikizo wofalitsa pa phunzirolo, loperekedwa ndi Rush University Medical Center komwe kufufuzakuchitika, Dr. Bianco ananenanso kuti:
Ngakhale cholinga chenicheni ndi kuchiza odwala kukhala bwino, zizindikiro zokha sizimagwiritsidwa ntchito poweruza mankhwala okwanira. Maselo a TSH a magazi ndi. M'mawu ena, mlingo wa levothyroxine umasinthidwa pogwiritsa ntchito miyeso ya TSH osati ngati wodwalayo akumverera bwino kapena ayi ... Chofunika kwambiri kumvetsetsa ndikuti T4 si ma hormone yogwira ntchito. T4 ayenera kutembenuzidwira ku T3 ndi matupi athu ndi enzyme yotchedwa deiodinase.
Odwala amadandaula kuti ali ovutika maganizo, ochedwa komanso oganiza bwino. Zimakhala zovuta kutaya thupi. Amadandaula kuti amamva kuti ali opusa komanso alibe mphamvu. Komabe ife madokotala timapitiriza kuwauza kuti, "Ndikukupatsani mankhwala abwino komanso TSH yanu ndi yachibadwa. Muyenera kumverera bwino."
Zotsatirazi zikugwirizana ndi zomwe odwala amatiuza. Zophunzira izi kwa nthawi yoyamba, mosasamala, kuti odwala pa levothyroxine amve moipitsitsa ndipo sagwira ntchito mochepa kusiyana ndi kulamulira, kuwonetsa zovuta zedi za cardiometabolic ngakhale kuti ali ndi magulu oyenera a TSH.
Dr. Bianco ndi mmodzi mwa atsogoleri mu kayendetsedwe ka kufufuza ngati zofooka za mthupi mwa odwala ena zingasokoneze ntchito ya deiodinase ndi kuwononga kutembenuka kwa T4-to-T3, komanso ngati kuwonjezera kwa T3 ku levothyroxine monotherapy kungabweretse bwino zizindikiro, umoyo woleza mtima wa moyo, ndi magawo abwino a thanzi la anthu ena omwe amathandizidwa ndi hypothyroidism.
Dr. Bianco adanena poyera kuti amakhulupirira kuti mankhwala abwino ndi oyenera kuti athe kuchiza matenda a hypothyroidism. Padakali pano, amalimbikitsa kuti madokotala asachoke ku chikhalidwe, "chosavuta kuchiza, kumwa mapiritsiwa ndipo mukhale bwino" poyandikira kuchipatala, ndipo mmalo mwake, chitani njira yosiyana mukamalangiza odwala za mankhwala a hypothyroidism. Malingana ndi Dr. Bianco:
Madokotala ayenera kuwauza odwala awo kuti, "Ndidzaonetsetsa kuti TSH yanu ikhale yovuta, koma mudzakhala pachiopsezo chachikulu chopeza kulemera, kuvutika maganizo ndi kutopa. Komanso ndizotheka kuti cholesterol yanu ikwere." Ndicho chimene tiyenera kuwuza odwala, pogwiritsa ntchito phunziro lathu.
Zimene Kafukufuku Amenewa Akukutanthauza
Kwa zaka makumi awiri, ovomereza odwala ndi madokotala ena akhala akunena kuti levothyroxine monotherapy sayenera kukhala njira yokhayo. Ngakhale kuti imagwira ntchito kwa anthu ena omwe ali ndi hypothyroidism, odwala ambiri samamva bwino, ngakhale kuti amachiritsidwa ndi levothyroxine, ndipo amawoneka kuti ndi euthyroid ndi maselo a "TSHASI" nthawi zonse, malinga ndi mayeso a magazi.
Kudzipereka kwa Dr. Bianco kuti afufuze ndikukonzekera umboni wokhudzana ndi kufunika kwa mankhwala okhudzana ndi T4 / T3 mu gawo la odwala hypothyroid ndiwodalirika komanso odalirika. Ndipo inde, monga Dr. Bianco adanenera, mankhwala abwino ndi ofunika kuti azisamalira hypothyroidism.
Pakalipano, pali mwayi kwa odwala omwe Dr. Bianco sakuvomereza poyera. Mutha kukhala ndi Free T3 kuyesa, ndipo ngati ili yochepa kapena yosakwanira, mungagwire ntchito ndi dokotala yemwe angawonjezere mankhwala a T3 - monga Cytomel (liothyronine), kapena mankhwala owonjezera, mankhwala, mankhwala osokoneza nthawi T3 -kuchipatala chanu, kapena ndani amene angapereke mankhwala achilengedwe monga mankhwala owonetsa zachilengedwe kapena Armor Thyroid kwa inu.
> Zotsatira:
> Kukambirana ndi Antonio Bianco, MD. MedicalResearch.com. October, 14, 2016.
> Rush University Medical Center. Lamulo Loyamba: Zizindikiro za Hypothyroidism zimakhalabebe ngakhale kuti amagwiritsa ntchito mankhwala, kuyesera magazi. October 12, 2016. Science Daily.
> Sarah J. Peterson, Elizabeth A. McAninch, Antonio C. Bianco. Kodi TSH Yodziwika ndi "Euthyroidism" mu Levothyroxine Monotherapy? Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2660