Mkonzi wochokera kwa Mary Shomon
Chimodzi mwa mavuto omwe amakumana nawo odwala chithokomiro ku United States ndi padziko lonse ndi omwe odwala ayenera kudzipangira okha kuti athetse vuto la chithokomiro, makamaka chithokomiro chosagwira ntchito. Pamene ndikunena kuti "ndikuchiritsa," ndikutanthauza kugula mankhwala osakaniza a chithokomiro m'malo mwa dokotala, ndipo kenako kumwa mankhwalawo popanda dokotala.
(Ine sindikunena za odwala omwe madokotala awo amapereka chithandizo cha chithokomiro koma amalola odwala kukwera kapena kutsika muyezo pakati pa kuyendera.)
Kudzipiritsa mankhwala a hypothyroidism kumakhala ndi zovuta zina zoonekera kwa odwala.
Choyamba, ngati munthu sanawone ngati hypothyroid, koma m'malo mwake, kudzipenda yekha, ndiye kuti vuto lina lingawonongeke - ndipo sichidzasinthidwa. Zizindikiro monga kutopa, kupindula, ndi kupsinjika maganizo ndizofala mu hypothyroidism, koma zimakhalanso zizindikiro za zinthu zina zambiri - zovuta kwambiri. Kulephera kupeza chithandizo choyenera ndi chithandizochi kungakhale kowopsa kwa wodwalayo amene amadzipangitsa kudzidzimva yekha ndi kudzipangira yekha mankhwala omwe amati ndi hypothyroidism.
Chachiwiri, ntchito ya chithokomiro nthawi zonse imakhala yolimba. Anthu amatha kukhala ndi nthawi yochepa ya hypothyroidism chifukwa cha mankhwala, chithokomiro, kapena chithokomiro cha postpartum pambuyo pa kubadwa kwa mwana, kenaka kubwereranso ku chithokomiro choyenera.
Mankhwala oyenera akhoza kuchepa msanga pamene chithokomiro chimasinthasintha.
Chachitatu, pali chiopsezo chotengeka. Kudzipatula kumapangitsa kuti pakhale mavuto ambiri kuphatikizapo matenda a mtima, kunenepa kwambiri, ndi kuvutika maganizo. (Zoona, kulandira chithandizo konse kwa hypothyroidism kumapanganso ngozi yaikulu ya matendawa.)
Koma chachinai ndi chodetsa nkhaŵa chachikulu kwa anthu ambiri ndizoopsa kuti awo omwe amamwa mankhwala adzalandidwa. Kutenga mankhwala ambiri a chithokomiro m'malo mwake kumayambitsa zizindikiro zosiyanasiyana, kuphatikizapo nkhawa, mantha, mantha, kutsekula m'mimba, kuthamanga kwa magazi, tachycardia (kuthamanga mtima kwa mtima), kuthamanga kwa mtima, mtima wamaganizo, ndi mtima woopsa wosadziwika. monga atrial fibrillation . Matenda a atrial - omwe nthawi zina amawatcha "a-fib," angayambitse matenda osokoneza bongo, omwe nthawi zina amachititsa kulema kwamuyaya komanso imfa.
Odwala ena amanena kuti kudzipiritsa kumakhala kotetezeka ngati odwala ali odziwa bwino. Ndikudziwa odwala angapo amene adzichitira okha zabwino. Pa nthawi yomweyi, ndamvanso kuchokera kwa odwala ambiri a chithokomiro amene amatha kukhala m'chipinda chodzidzimutsa chifukwa chodwala mankhwala opatsirana pogonana. Ambiri mwa odwalawa anali odziwa bwino kwambiri komanso owerengedwa bwino pa nkhani ya matenda a chithokomiro, ndipo ankadziona kuti ndi odziwa bwino kwambiri pankhani yodzipangira okha hypothyroidism. Komabe, anamaliza kuledzera ndipo anayenera kukumana ndi vuto lalikulu la thanzi.
Ngakhale odwala ambiri - ngakhale omwe amadzikayikira pazodziŵa zawo - amadziwa kuti pali chiopsezo chodzipangira mankhwala, chizoloŵezichi chikuchitikabe chifukwa odwala ali ndi zovuta zambiri zomwe zimawalepheretsa kupeza chithandizo choyenera ndi chithandizo cha chithokomiro choyenera .
Kodi zotchingazi ndi ziti?
Choyamba, pali anthu amene anapeza kuti ali ndi hypothyroidism m'mbuyomo, koma omwe sangakwanitse kulipira madokotala. Ku US nokha, tili ndi mamiliyoni ambiri osatetezedwa, mamiliyoni ambiri a anthu okalamba omwe ali ndi ndalama zokwanira, komanso mamiliyoni ambiri a ku America amene ataya ntchito panthawi yachuma. Anthu ambiri sangathe kulipira ngongole kwa madokotala. Padziko lonse lapansi, kupeza madokotala abwino ndi chithandizo chamankhwala ndi mwayi wa kujambula, ndipo kumadalira geography, chuma, chithandizo chamankhwala chofala, komanso zachuma.
Chachiwiri, madokotala ambiri amakhalabe osokonezeka pa momwe angatanthauzire chithokomiro choyambitsa mahomoni (TSH) - mayesero omwe amachitcha kuti "golide" kuti apeze tizilombo toyambitsa matenda.
Ngati wodwala ali ndi zizindikiro za hypothyroidism, ndipo ali ndi zotsatira zoyesa zomwe zimagwera m'dera la "limbo" la testamento la TSH - pamwamba pa 2.5 ndi pansi pa 4.0 mpaka 5-5.5 - zotsatira za TSH za wodwalayo zimatchedwa ma Labs monga "zachizolowezi" lipoti la labu. TSH m'magulu oterewa amaganiziridwa kuti ndi hypothyroidy ndi akatswiri ena, komabe. Ophunzira a Endocrinologist akhala akumenyana ndikukangana pa nkhaniyi kwa zaka pafupifupi khumi, kuyambira pamene American Association of Clinical Endocrinologists (AACE) inalimbikitsa kumayambiriro kwa chaka cha 2003 kuti kafukufuku wamtundu wa TSH akhale wochepa mpaka 0,3 mpaka 3.0 . Madokotala ambiri amatsatirabe cutoff point, ndipo amatha kudziwa ndi kuchiritsa hypothyroidism ngati wodwala ali ndi TSH yomwe ili yaikulu kuposa 4.5 mpaka 6.0.
Chachitatu, pali odwala omwe ali ndi zizindikiro za hypothyroidism, ndipo ndani amene amatchedwa "zachibadwa" zotsatira pa kuyesa kwa TSH- akugwa paliponse pakati pa 3 ndi 6.0 - koma omwe adakweza matenda a chithokomiro akusonyeza matenda a Hashimoto. Madokotala ambiri sakudziwa - kapena samachita molingana ndi - kafukufuku amene amasonyeza kuti mwa odwala ena omwe ali ndi kachilombo ka HIV, chithandizo cha chithokomiro chingathe kuchepetsa zizindikiro za hypothyroid ndi kupeŵa kupita patsogolo kuti mukhale ndi matenda opatsirana pogonana.
Chachinai, pali odwala omwe ali ndi "TSH" yeniyeni, koma mavoti oyendayenda a hormone ya chithokomiro - Free T4 ndi Free T3 - amasonyeza kufooka koyera mu mahomoni awa. Madokotala ambiri amakana kuvomereza kuti zovuta kapena zochepa za Free T4 ndi / kapena Free T3 - komanso miyezo yowonjezereka ya T3 kapena zosayenera zofanana za Reverse T3 / Free T3 - zimasonyeza hypothyroidism. T4 amasandulika kukhala T3 - mahomoni otentha a chithokomiro pamasom'manja. Madokotala ambiri amaganiza kuti aliyense angathe kusintha T4 kukhala T3 bwino komanso mofanana. Pakalipano, madokotala ophatikizana, ndi akatswiri ena odziwa zachipatala, avomereze kuti odwala ena akhoza kukhala ndi ma antibodies, kulephera kwa enzyme, kulephera kwa zakudya, kapena zofooka za thupi zomwe zimawononga T4 mpaka T3 kutembenuka, komanso kuti vutoli likhoza kulandira mankhwala.
Ochisanu, odwala ambiri amachiritsidwa ndi mankhwala a levothyroxine - mwachitsanzo, Synthroid, Levoxyl, Levothroid, Eltroxin, kapena levothyroxine / l-thyroxine, koma ali ndi kachilombo ka hypothyroidism, ngakhale atachiritsidwa akubwezera zotsatira za mayendedwe a " zachibadwa. " Ena mwa odwalawa akupempha kuwonjezera mankhwala a T3 - mwachitsanzo, Cytomel (liothyronine), kapena kutulutsidwa nthawi ya T3 - kapena kupempha mankhwala ochiritsira omwe amatchulidwa ndi chithokomiro - mwachitsanzo, Zida, Nature-Throid, kapena Erfa. Kugwiritsira ntchito T3 kumatsutsana, komabe madokotala ambiri samakhulupirira kugwiritsa ntchito mankhwala a T3 kapena mankhwala a chithokomiro. Madokotala awa nthawi zambiri amanena kuti palibe mankhwala enaake a chithokomiro omwe amafunika chifukwa chakuti zizindikiro sizili zokhudzana ndi chithokomiro, kapena kuti zizindikiro ndizo umboni wa matenda aumoyo ndipo zimapangitsa kuti munthu asamalimbikitse mankhwala. Kawirikawiri, timamva "palibe yemwe amafunikira T3 kapena chithokomiro chachilengedwe" chifukwa "aliyense amatembenuza T4 kupanga T3 kwathunthu." Izi "simukusowa / aliyense amatembenuza T4 mpaka T3" mantra ndi yotchuka komanso yosatha myt
h mu mankhwala a hypothyroidism. Madokotala ena amakana kupereka T3 ndi / kapena mankhwala a chithokomiro chifukwa amalingalira kuti mankhwalawa amachititsa munthu kukhala ndi vuto la mtima. Koma zoopsa sizikhala zochepa pamene mankhwalawa amagwiritsidwa ntchito moyenera. Kwa odwala ena omwe ali ndi thanzi labwino, chiopsezo cha T3 ndi mankhwala a chithokomiro chachilengedwe ndi ngati wodwalayo akuledzera kwambiri. Komabe, madokotala ndi ochenjera ngakhale ali ndi odwala okalamba ndi odwala omwe ali ndi matenda a mtima, omwe ali ndi kachilombo ka HIV. (N'zochititsa chidwi kuti palinso kafukufuku amene amasonyeza kuti hypothyroidism yosatetezedwe imawonjezera ngozi ya matenda a mtima .)
Chachisanu ndi chimodzi, pali odwala omwe ali ndi mabungwe okonza zaumoyo (HMOs) kapena inshuwalansi ya zachipatala, omwe madokotala awo amakana ngakhale kuyesa matenda a hypothyroidism, kukana kugwiritsira ntchito boundline / subclinical hypothyroidism, kukana kudwala matenda a Hashimoto, kukana kuyesa kapena kulandira Free T4 / Kusagwirizana kwa T3 / kusayenerera, ndi / kapena kukana kupereka mankhwala a T3 ndi / kapena mankhwala a chithokomiro. Odwala ena akuwona madokotala awa alibe ndalama zomwe sangathe kulipira m'thumba kuti azipita kuchipatala chowonjezera cha chithokomiro.
Pomaliza, kunja kwa US, kudzipiritsa kumakhala kofunikira kwa odwala ena. Mwachitsanzo, ku United Kingdom, anthu ambiri amagwiritsa ntchito National Health Service (NHS) kuchipatala chawo. Madokotala a NHS amafunikanso kuti azitsatira mwamphamvu kwambiri, mwina angati, nthawi yayitali komanso nthawi zambiri zolakwika - pofufuza ndi kuchiza hypothyroidism. Pa nthawi yomweyo, pali madokotala ochepa okha omwe amadziŵa bwino matenda a hypothyroidism, ndipo madokotalawa amakhala okwera mtengo kwambiri.
Odwala Matenda a Chithokomiro
Kotero, pamapeto, kodi odwala ayenera kudzipangira mankhwala, kapena ayi? Ndangoyambitsa chisokonezo pakati pa odwala omwe amadzipangira okha mankhwala chifukwa ndanena kuti sindikulimbikitsa kudzipiritsa, komanso kuti gulu lachilengedwe la Save Natural Thyroid - gulu lomwe ndinakhazikitsa m'chilimwe cha 2009 kuthandiza opirira kuthana ndi kusoŵa, kusowa kwachangu komanso Kusokoneza kwa FDA pa mankhwala omwe amadziwika ndi mankhwala a chithokomiro - samalimbikitsanso kumwa mankhwala.
Palibe kukayikira kuti odwala ali m'mavuto. Ndipo zimamveka bwino kwa ine kuti odwala ena amawona kuti alibe njira ina koma kuti adzipange mankhwala. Sindikudzudzula yekha ufulu wodzisamalira - ndicho chinthu chimene munthu aliyense ayenera kusankha yekha. Zimakhala zomvetsa chisoni kwambiri kuti anthu ena amakakamizika kusankha kusankha, ndipo ndimakwiya kwambiri ndi momwe madokotala ena amaonera matenda a chithokomiro, omwe amachititsa odwala kuti asankhe. Ndimakhulupirira ndi mtima wonse kuti iwo omwe amadzipangira okha amachitira motero mosamala kwambiri ndipo amatha kupeŵa mavuto alionse.
Cholinga cha odwala ena ndikukhulupirira kuti ndikulimbikitsanso kumwa mankhwala - makamaka, kulimbikitsa kudzipiritsa ndi chithokomiro chodziwika bwino.
Takhala tikukumana ndi mankhwala osokoneza bongo chifukwa chosowa mankhwala kapena mankhwala osokoneza bongo , zoperewera zopanda pake, komanso zochitika zozizwitsa zomwe zikuwoneka ngati zikutsogoleredwa ndi zochitika za FDA. Mankhwala osokoneza bongo amtundu wachilengedwe amakhalanso m'ndandanda wa madokotala "osagwirizana" a FDA omwe adzakakamizidwa kuti adutse mwachindunji. The FDA yatsimikizira kuti chithokomiro chachilengedwe ndi mankhwala osagonjetsedwa, ndipo sanabale, ndipo kuti pamapeto pake adzayenera kudutsa njira yobvomerezedwa kuti akhalebe pamsika. Nthawi ndi momwe zidzakhalire akadakonzedweratu. Njira ya FDA yopanga zisankho zovomerezeka sizowonekera. Zomwe tikudziwa ndizoti zandale ndi zachuma zomwe zikuchitika pamasewera - mphamvu zomwe sizikukhudzidwa ndi chithandizo chamoyo - nthawi zambiri zimayendetsa polojekiti.
Madokotala ena, komanso akuluakulu a FDA anandiuza, kuchokera pa mbiri, kuti amamva kuti zoipa zabodza - kuphatikizapo m'magazini a zachipatala - zokhudzana ndi chithokomiro chodzipiritsa zamasamba zakhala zikuyendetsa mankhwala osokoneza bongo kuti asamawonongeke - ndipo zachititsa mwa iwo kufufuza mozama ndi FDA.
Chinthu chinanso choletsera mankhwala osokoneza bongo ndi Dr. Sidney Wolfe wa Boma, yemwe adasankhidwa ku FDA's Drug Safety ndi Risk Management Advisory Committee. Pazifukwa zina zomwe zidakali zophweka, zosokoneza Dr. Wolfe - amene nthawi zina adanena kuti chithokomiro chachilengedwe ndi chowonjezera (osati), ndipo chimapangidwa kuchokera ku ng'ombe (ndi porcine, nkhumba) - - ali wotsutsana ndi chilengedwe cha chilengedwe (kapena chilichonse chomwe amakhulupirira kuti chilengedwe chimakhala ndi chithokomiro.) Iye analemba diatribes yodzala ndi zolakwika za Armor Thyroid muzolemba za "Odwala Piritsi, Mapiritsi Opambana" kutumikira ku komiti ya FDA. Tsopano ali ndi udindo wosankha mankhwala omwe amatha kumapeto kwa kampeni ya FDA's Non-Approved Drugs.
Ndipo chovuta chachikulu chikhalebe chithokomiro "kukhazikitsidwa" - ndipo pano ndikuphatikizapo madokotala otchedwa endocrinologists, madokotala ochiritsira, magulu a zamankhwala a chithokomiro, a FDA, ena a malamulo, ndi makampani akuluakulu a mankhwala omwe amachititsa levothyroxine - omwe ali okondwa kugwira ndi kupanga udzu Kuchokera kwa ANY ndi mauthenga onse olakwika, zotsatira zoipa, kapena mavuto omwe amapezeka ndi chithokomiro chachilengedwe ndi / kapena mankhwala a T3, akuyembekeza kugwiritsa ntchito nkhani zoipa ngati njira yothetsera mankhwalawa pamsika. N'zomvetsa chisoni kuti, "zodetsa nkhaŵa" nthawi zambiri sizikugwirizana ndi chithandizo cha odwala komanso chilichonse chochita ndi kudzikonda, kupeza phindu, chithokomiro, kapena chinyengo.
Mission My Advocacy Mission: Kugwira Ntchito Kugonjetsa Thythink Group
Monga wochirikiza odwala, ndikufuna kuika chidwi changa pothandiza kuphunzitsa ndikudziwitsa anthu, ndikulimbikitsa kusintha kwa dongosolo lomweli. Potsirizira pake, ndikufuna kuti tikhale m'dziko limene odwala ambiri amatha kupanga chisankho chovuta pakati pa kudzipiritsa - komanso kuopsa kwake komanso phindu lake - komanso popanda chithandizo.
Musakhululuke, ichi ndi cholinga chovuta. Nkhondo yolimbana ndi dziko lachidziwitso la zachipatala, ndi "bizinesi" ya mankhwala a chithokomiro - ndipo madokotala angapo amatcha "nkhanza za TSH" - ndizovuta. Ndi nkhondo ambiri a ife takhala tikulimbana zaka zoposa khumi. Takhala tikuwona kusintha kwina, ndi zovuta zina panjira.
Monga momwe tikudziwira, kuchokera ku lingaliro la zachipatala / za sayansi, mabungwe ambiri otchedwa endocrinologists ndi mabungwe a mapologalamu otchedwa endocrinology amachedwetsa kusintha, ndipo, zomvetsa chisoni, nthawi zambiri amawoneka ofunika kwambiri ku chiwerengero cha lipoti la lala kuposa wodwalayo amene wakhala patsogolo pawo komanso ngati wodwala akusangalala khalidwe lililonse la moyo. Madokotala amadalira mayeso a TSH - mayesero achiwiri a hormone ya pituitary - kuti azindikire ndikusamalira hypothyroidism, pamene akumva kuti ndibwino kunyalanyaza zonse za Free T3 - mahomoni ogwira ntchito omwe amalowa m'maselo kuti apereke mpweya ndi mphamvu. Madokotala ambiri samadetsa nkhawa kuti ayesetse tizilombo toyambitsa chithokomiro - zomwe zingatiuze pamene chithokomiro chimalephera.
Pakalipano, mibadwo yambiri ya akatswiri otchedwa endocrinologists ndi madokotala akhala akuuzidwa kuti mankhwala anu a thyroxine (T4) - omwe amadziwika kuti levothyroxine / l-thyroxine - kapena zambiri, ndi dzina lakuti Synthroid - ndilo lingaliro lokhazikitsa. Awuzidwa kuti levothyroxine yekha ndi yabwino kuposa mankhwala othandizana ndi triiodothyronine (T3) - wotchedwa liothyronine (Cytomel). Iwo auzidwa kuti chithokomiro chodziwika bwino - chomwe chinali, kwa theka la zana okha mankhwala a hypothyroidism - ndi "achikale," "osasunthika," ndipo ndi otsika kwa mankhwala anu thyroxine. Sayansi yeniyeniyi ili ponseponse, koma, ndi mankhwala alionse omwe dokotala amalimbikitsa - kaya ndi levothyroxine monotherapy, mankhwala opangidwa ndi T4 / T3 othandizira, kapena kugwiritsa ntchito mankhwala otentha a chilengedwe - pali maphunziro omwe angayimire malo awo osankhidwa. Ndipo pamene dokotala akukumana ndi phunziro lomwe limatsutsana ndi lingaliro lake, nthawi zambiri mumamva iwo akunena, "chabwino, ndi 'zoipa' kuphunzira."
Kuwonjezera pa mkangano wa zachipatala / za sayansi, makampani azachipatala madola amakhala ndi zotsatira zowawa pamaganizo a athandizi a chithokomiro.
Si chinsinsi chakuti magulu a chithandizo chamatenda a chithokomiro - mwachitsanzo, American Thyroid Association, ndi American Association of Clinical Endocrinologists - amapeza madola masauzande ambiri chaka chilichonse mu zopereka, ndalama, chithandizo, ndi chithandizo chochitika kuchokera kwa opanga Synthroid. Ndipo madokotala ambiri omwe ali ndi maudindo mu utsogoleri m'mabungwe awa amalandira ndalama kuchokera kwa wopanga Synthroid.
Chinthu cha synthroid cha levothyroxine chakhala mankhwala osokoneza bongo ku US kwa zaka zambiri, ndipo ndi zopindulitsa kwambiri. Ku sukulu zachipatala, maofesi a endocrinologist, ndi ogwira ntchito m'chipatala malo odyera kudziko lonse, masitini a masana ndi madengu a muffin amafika nthawi zonse, amalipira ndi wopanga Synthroid, monga njira yothandizira kutsimikizira kuti masomphenya awo a chithokomiro - omwe sali nawo T3 ndi chithokomiro chachilengedwe - ndi omwe madokotala, anamwino, ogwira ntchito ku ofesi, ophunzira azachipatala ndi madokotala achinyamata amamva. Ndipo musaiwale mapepala a malonda - kuphatikizapo mankhwala osokoneza bongo komanso mapepala, mapepala, mabuku, mapepala a pulasitiki, mapulasitiki omwe amasonyeza chithokomiro, ndi zinthu zina - kuti mankhwala opatsirana mankhwala amaperekedwa ndi zikwi sabata iliyonse kupita ku madokotala , ndikupereka pamsonkhano uliwonse wa zachipatala.
Chotsatira cha zotsatira: tili ndi mibadwo ingapo ya madokotala omwe amayenda pang'onopang'ono, kukhulupirira - ndikupitirizabe kumvetsera uthenga kulikonse - Synthroid ndiyo njira yothetsera yankho kwa aliyense ndi aliyense yemwe ali ndi hypothyroidism, kuti aliyense atembenuke T4 kwa T3 mwangwiro, kuti palibe amene amafunikira T3, ndipo kuti palibe njira yowonetsera chithokomiro mu mankhwala a hypothyroidism.
Chithokomiro komanso kuganiza kwa madotolo ena kuti zisonkhezero zachuma zikufala kwambiri kuti pali ena ena omwe amatha kutsutsa zachipatala ndi madokotala omwe amatsutsa pagulu ndi madokotala anzawo omwe amapereka mankhwala a T3 kapena mankhwala a chithokomiro kwa odwala.
Kuchita chirichonse chomwe ndingathe kuti ndithandizire kuthetsa kuganiza kotereku - kuganiza kuti kumatsutsa anthu ambiri kumoyo wodwala - ndilo cholinga chachikulu cha ulaliki wanga.
Cholinga changa ndi kulimbikitsa kuzindikira zamtundu wa mankhwala omwe angapangidwe mwalamulo - kuphatikizapo T3 ndi mankhwala a chithokomiro. Cholinga changa ndikugwira ntchito kudziko limene chithandizo cha chithokomiro chovomerezeka chidzadziwika bwino, kudziwika bwino, kukuvomerezeka bwino, kotsika mtengo, komanso kovomerezeka mwalamulo ... dziko limene lingamvetsetse bwino madokotala, inshuwalansi, apamtima, mabungwe azachipatala, komanso odwala onse omwe angakhale ndi chithandizo cha chithokomiro chovomerezeka. Ndipo powonjezera, ntchito yanga ndikuteteza kuteteza izi motsutsana ndi magulu osiyanasiyana omwe akufuna kuti awone atachoka pamsika.