Matenda a khunyu omwe amachititsa magazi (TSH) kuyesa magazi amachitidwa ndi madokotala ena kuti akhale oyambirira-ndipo nthawi zina mayesero okhawo amafunika kuti muwazindikire ndi kusamalira chithokomiro chanu chosagwira ntchito, chomwe chimatchedwa hypothyroidism kapena hyperthyroidism . Nthaŵi zina mayeso a TSH amatchulidwa ndi akatswiri odziwika bwino a "endocrinology" monga "kachitidwe ka golide" pofuna kupeza ndi kuchiza chithokomiro.
Kodi TSH imayeza chiyani?
Chiyesocho chimayeza kuchuluka kwa TSH yanu, hormone yomwe imapangidwa ndi kutulutsidwa ndi gland yanu. Nthenda yanu yodziwa ngati muli ndi mavitamini otere okwanira mumagazi anu, ndipo ikazindikira kuti siikukwanira, kachilombo kanu kamatulutsa TSH kuti mutulutse chithokomiro chanu kuti mutulutse mahomoni ambiri a chithokomiro. Ichi ndi chifukwa chake TSH yanu imatuluka pamene chithokomiro chanu sichitha . Kuthamanga kwa TSH kumatanthawuza kuti chifuwa cha pituitary chimamasula mahomoni ake kuti ayesetse kuti chithokomiro chiyankhe mwa kupanga mahomoni ambiri a chithokomiro.
Pamapeto pake, pamene chifuwa chanu chikumva kuti pali mahomoni ochuluka kwambiri otuluka m'thupi, ndiye kuti imachepetsanso kapena imasiya kutulutsa TSH. Kutsika kwa TSH kukutanthauza kuti chithokomiro chanu sichikupezekanso uthenga womasulira mahomoni, ndipo kupanga mahomoni otulutsa chithokomiro amatha kuchepa.
Mtundu Wotchulidwa TSH
Kuyambira mu 2017, ku ma laboratories ambiri ku United States, mauthenga ovomerezeka a ma ARV amayambira pafupifupi 0,5 mpaka 4.5 kapena 5.0 (mIU / L).
Wodwala yemwe TSH ali m'gulu la zolembera amatchulidwa kuti "euthyroid," ndipo amawonedwa kuti ali ndi chithokomiro choyenera.
Buku lotanthauzira-nthawi zina limatchulidwa kuti "nthawi zonse" -li mbali yofunikira ya pulojekiti yanu yonse yothandizidwa ndi chithandizo cha chithokomiro, chifukwa dziko lapansi lopangidwa ndi odwala matendawa limakhala lofunika kwambiri kuti lizindikire komanso kuyang'anira chithokomiro.
Kodi Tsh Reference Range Inatsimikiziranji?
Tsamba la TSH likupezeka pogwira kagulu ka anthu, kuyerekeza mazinga awo a TSH, ndi kuwerengera mtundu umene ukuyenera kuimira magulu osiyanasiyana a TSH mu anthu wathanzi.
Pogwiritsira ntchito mafotokozedwe otchulidwa, TSH pansi pa 0,5 (otsika TSH) angakhale chizindikiro cha hyperthyroidism (chithokomiro chopitirira muyeso), ndipo TSH yoposa 4.5 / 5.0 (mkulu wa TSH) ingasonyeze hypothyroidism (chithokomiro chopanda mphamvu).
TSH Reference Reference Controversy
Imodzi mwa nkhani zotsutsana kwambiri yakhala nkhani ya kusintha "zachizolowezi" zowerengera za mayeso a TSH. Kumapeto kwa chaka cha 2002, National Academy of Clinical Biochemistry (NACB) inapereka malangizo atsopano okhudza matenda ndi chithandizo cha chithokomiro.
Mu ndondomekoyi, NACB inanena kuti mtundu wa zolemba za TSH unali waukulu kwambiri ndipo unaphatikizapo anthu omwe ali ndi matenda a chithokomiro. Pamene kuwonetsetsa kovuta kwambiri, komwe kunapatula anthu omwe ali ndi matenda a chithokomiro, 95 peresenti ya anthu omwe anayesedwa anali ndi TSH pakati pa 0,4 ndi 2.5. Chotsatira chake, NACB idalimbikitsa kuchepetsa zowerengerazo ku mazinga awo.
Nkhokwe za NACB zatsogolera ku ndondomeko mu Januwale 2003 ndi American Association of Clinical Endocrinologists (AACE), kuitanitsa madokotala "kulingalira chithandizo kwa odwala omwe amayesa kunja kwa malire a chiwerengero chochepa kuchokera ku TSH mlingo wa 0.3 mpaka 3.0. " Msonkhanowu unanenanso kuti: "AACE imakhulupirira kuti njira yatsopanoyi idzapangitsa kuti anthu mamiliyoni ambiri a ku America akudwala matenda a chithokomiro, koma sanamvere mpaka pano."
Kafukufuku wofalitsidwa m'magazini ya Journal of the American Medical Association mu 2003, Dr. Vahab Fatourechi ndi ofufuza anzawo adanena kuti ngati zochepazo zikanakhala zochepa malinga ndi ndondomeko ya AACE, chiŵerengero cha anthu omwe ali ndi matenda a chithokomiro chidzawonjezeka kuchokera pafupifupi 5 peresenti ya chiŵerengero cha anthu pafupifupi 20 peresenti ya anthu, ndipo ambiri mwa odwala owonjezeka omwe akugwera mu hypothyroid / gulu losagwira ntchito.
Izi zikuyimira kuwonjezeka kwakukulu kwa odwala chithokomiro m'dziko lonse lapansi, kuyambira pafupifupi 15 miliyoni, kupita ku America okwana 60 miliyoni.
Panthawi imodzimodziyo, msonkhano wa mgwirizanowu wopangidwa ndi nthumwi zochokera ku magulu akuluakulu ogwira ntchito pa chithokomiro, kuphatikizapo American Association of Clinical Endocrinologists, American Thyroid Association, ndi Endocrine Society-adafalitsa zomwe anapeza mu 2004, chithandizo chachizolowezi cha odwala okhala ndi TSH ma 4.5 mpaka 10.0 mIU / L. Ndondomeko yatsopano yowonetsera zolembera yagonjetsedwa.
Pafupifupi zaka makumi awiri pambuyo pake, ma laboratories akuyesera ku America adagwiritsabe ntchito zakale zowerengera ndipo madokotala akhala akugawikana. Pakati pa madokotala ochiritsira, ambiri amapitirizabe kukana kugwiritsira ntchito hypothyroidism pokhapokha ngati zotsatira za TSH zakhala zosiyana ndi zomwe zimalembedwa ndi labotale.
Jeffrey Garber, MD, FACE, adatsutsana ndi a American Association of Clinical Endocrinologists (AACE). Malingana ndi Dr. Garber, malangizo sali oyenerera kuti agwiritse ntchito m'malo mwa chiweruzo chazochita za dokotala. Polemba mabuku ake, Dr. Garber wanena kuti sakuwona kuti kuchiritsa matenda a hypothylinism ndi koyenera, adanena kuti pakuchita izi, sazengereza kuchiza wodwala ndi TSH mkati mwazomwe akuwonekera kuti zikhale zothandiza.
Said Garber:
TSH yachibadwa ya TSH sayenera kukhala nkhani yowonongeka. Koma monga momwe kawirikawiri zimawonera zamankhwala, n'zosavuta kuvomereza pa zovuta. Mukayandikira kwa zomwe zili pamtunda, ndizovuta kwambiri. Tiyenera kuzindikira kuti ndizopitirira. Ngati anthu akudziwa kuti gululi liri ndi matenda a chithokomiro kusiyana ndi gulu lochepa, silimakupangitsani kuchipatala ndipo silinena kuti siloyenera, limati ndikutsatira, ndipo mwina limalowererapo.
Vuto la Odwala: "TSH Yanu Ndi Yachibadwa"
Buku la TSH reference range limakuvutitsani inu monga wodwala.
Dokotala wanu atalandira lipoti lanu la kuyesa mmbuyo, chirichonse mu malo otchulidwa sichidzakanidwe ngati chachilendo. Izi zikutanthauza, ngati dokotala wanu akudalira pazomwe akutsatiridwa ndipo amangochita zochitika kunja kwa zolembera zamtunduwu, simudzapezeka kapena mukuchiritsidwa.
Pamapeto pake, kuuzidwa kuti TSH yanu ndi "yachibadwa" sizothandiza. Chimene mukufunikira kudziwa kuchokera kwa dokotala wanu ndi mayankho a mafunso anai ovuta:
- Kodi ndondomeko yanga yeniyeni yowunikira TSH inali chiyani?
- Kodi ndikutanthauzira kotani pabubu komwe zotsatira zanga zapangidwe?
- Kodi mumatsata chithunzi chotani pakudziwa ndi kusamalira matenda a chithokomiro?
- Kodi cholinga chanu cha TSH ndi chiyani kuti ndithetse bwinobwino zizindikiro zanga?
Onetsetsani kuti mwapeza mayankho enieni a mafunsowa musanalole dokotala wanu kuti atulutse vuto la chithokomiro, kapena kukuuzani kuti chithokomiro chanu ndi "chachilendo," makamaka ngati mukukumana ndi zizindikiro .
Mawu Ochokera
Pamene mukukumana ndi odwala matenda otchedwa endocrinologists kapena madokotala ena omwe sakufuna kuti azindikire ndi njira ina iliyonse kusiyana ndi kutanthauzira kolimba kwa zotsatira za TSH, pakhoza kukhala nthawi yolandira chidziwitso chachiwiri kuchokera kwa wodwalayo, kapena kutambasula kufufuza kwanu kuti mukhale ndi dokotala wamkulu wa MD, osteopathic , kapena naturopath yophunzitsidwa ndi yovomerezeka .
Ogwira ntchito zambiri amapereka zifukwa zingapo kupyolera muyezeso wa TSH mu matenda ndi chithandizo cha matenda a chithokomiro, kuphatikizapo:
- Kuwonjezera magazi , monga T4 , T3, ndi ma antibody
- Kuyezetsa magazi kwa zizindikiro zowoneka za matenda a chithokomiro, kuphatikizapo kusintha kwa maganizo, kutupa ndi kupweteka kwa nkhope yanu ndi mapeto, kupweteka kwa tsitsi kumutu ndi thupi, kutayika kwa m'mphepete mwa nsidze, kukulitsa kwa chithokomiro, kusintha kwa maso, kuthamanga kwa mtima, kuthamanga kwa magazi, ndi zizindikiro zina zowoneka
- Kuyeza mayesero kuti adziwe kutambasula kwa chithokomiro , atrophy, ndi mitsempha
- Mbiri yachipatala yaumwini ndi ya banja
- Cholinga cha chithandizo cha "mulingo woyenera" magulu a TSH ndi kuthetsa zizindikiro
> Zotsatira:
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL / Wolters Kluwer; 2012.
> Fatourechi V, Klee GG, Grebe SK, et al. Zotsatira za kuchepetsa malire apamwamba a chikhalidwe cha TSH. JAMA. 2003; 290: 3195-3196.
> Garber, J, Cobin, R, Gharib, H, et. al. Malangizo Okhudza Zipatala za Hypothyroidism M'zochitika Zakale: Ambiri amathandizidwa ndi American Association of Clinical Endocrinologists ndi American Thyroid Association. " Chitetezo cha Endocrine. Mph. 18 No. 6 Novemba / December 2012.
> Gursoy A, ndi. al. "Kodi ndiyeso iti ya mahomoni yotulutsika ya chithokomiro iyenera kuyendetsedwa mu odwala hypothyroid pansi pa mankhwalawa a L-thyroxine?" Int J Clin Pract. 2006 Jun; 60 (6): 655-9