Kusamalira Matenda a Chithokomiro Panthawi Ndiponso Pambuyo Pathupi Wanu

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Kusamalira Matenda a Chithokomiro Panthawi ndi Pambuyo pa Kutenga: Malangizo

Matenda a chithokomiro amadziwika kuti amakhudza mbali zambiri za mimba ndi postpartum thanzi, komanso thanzi la mwana wanu. Poyesera kukonza zosiyana ndi zina zomwe zimatsutsana ndi matenda a chithokomiro komanso kutenga mimba, malangizo okhudza chithandizo cha chithokomiro panthawi yoyembekezera komanso panthawi yoberekera anafalitsidwa kumapeto kwa 2011, ndipo pofika mu 2016, amaonedwa ngati akutsutsidwa.

Magazini yotchedwa Thyroid inafotokoza malangizo monga tsamba la masamba 47, lolembedwa kuti "Zotsatira za American Thyroid Association kuti Zidziwitso ndi Kulamulira Matenda a Chithokomiro Pakati pa Mimba ndi Postpartum" . Nkhaniyi ikuphatikizapo zina mwazimene zimaperekedwa pazitsogozo, zomwe zimakhudza kwambiri ngati mukudwala matenda a chithokomiro panthawi yomwe muli ndi mimba, kapena inu amene muli ndi matenda a chithokomiro musanakwatire.

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Zimene Mukuyenera Kudziwa Ponena za Kujambula kwa Chithokomiro pa Mimba

Kawirikawiri, kuyang'anitsitsa chithokomiro kwa amayi omwe ali ndi pakati sikulingalira malinga ndi Malangizo. Komabe, akatswiri amanena kuti kuwonetsetsa ndi kuwunika kumachitika pakati pa amayi omwe ali ndi chiopsezo chachikulu cha matenda a chithokomiro.

Ndiwe chiopsezo chachikulu cha matenda a chithokomiro panthawi ya mimba ngati:

• khalani ndi mbiri yakale ya kutsekula kwa chithokomiro ndi / kapena opaleshoni ya chithokomiro
• khalani ndi mbiri ya banja la matenda a chithokomiro
• khalani ndi goiter
• kuyesa zowonjezera ma antibodies apamwamba
• ali ndi zizindikiro kapena zozizwitsa zomwe zingawononge hypothyroidism
• ndi mtundu wa shuga wa mtundu
• khalani ndi mbiri ya kuperewera kwa amayi kapena kuperekera kumbuyo
• Zili ndi vuto lina lomwe limagwirizanitsa ndi vuto la chithokomiro, monga: vitiligo, adrenal insufficiency, hypoparathyroidism, atrophic gastritis, kuwonongeka kwa magazi m'thupi, systemic sclerosis, systemic lupus erythematosus ndi matenda a Sjogren
• akhala akulephera
• adalandira kale ma radiation kumutu kapena kumutu ngati chithandizo cha khansa, kapena amakhala ndi mazira ambiri a mano
• ali olemera kwambiri, omwe amatanthauza kuti thupi la misala (BMI) laposa 40, kapena kulemera kwa thupi komwe kuli 20% kapena kuposerapo polemera thupi
• ali ndi zaka 30 kapena kuposa
• akhala akuchitidwa ndi amiodarone (Cordarone) chifukwa cha zovuta za mtima
• akhala akuchitidwa ndi lithiamu
• akhala akudziwidwa ndi ayodini mu mayeso a zamankhwala wosiyana wothandizila m'masabata asanu apitayi,

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Zimene Muyenera Kudziwa Zokhudza Hypothyroidism ndi Kumimba

Mankhwala a Hyperothyroidism pamene muli ndi pakati akhoza kukhala ndi thanzi labwino pa mwana wosabereka, ndipo momwemo mayi ayenera kutetezedwa.

Ngati muli ndi hypothyroid musanayambe mimba, Malangizowo amavomereza kuti mlingo wanu ukhale wosinthika kuti TSH ili pansi pa 2.5 mIU / L musanayambe kutenga pakati . Izi zimachepetsa chiopsezo cha TSH kukweza mu trimester yoyamba.

Muyeneranso kutsimikiziranso kutenga mimba mwamsanga, ndipo khalani ndi dongosolo kuti muwonjezere mlingo wanu wa mankhwala nthawi yomweyo , kuti muteteze mimba yanu pothandizira chithokomiro chanu.

Ngati mwapezeka ngati hypothyroid pa nthawi ya mimba, muyenera kuchiritsidwa mwamsanga, ndi cholinga chobwezeretsa chithokomiro chanu mofulumira mwamsanga. Pakati pa trimester yoyamba, chiwerengero cha TSH chiyenera kusungidwa pakati pa 0.1 ndi 2.5 mIU / L, 0,2 mpaka 3.0 mIU / L patsiku lachiwiri, ndi 0.3 mpaka 3.0 mIU / L mu 3 trimester .

Panthawi yomwe muli ndi masabata anayi kapena asanu ndi limodzi, mimba yanu ya mankhwala a chithokomiro nthawi zambiri iyenera kuwonjezeka, mwina mwa magawo 50 peresenti .

Ngati muli ndi matenda a chithokomiro, mwachitsanzo, mwakhala mukuyesera kuti mukhale ndi kachilombo koyambitsa matenda a chithokomiro, muli pachiopsezo chokhala ndi hypothyroid nthawi iliyonse yomwe muli ndi pakati. Muyenera kuyang'aniridwa nthawi zonse kudzera mimba ya TSH yokweza.

Muyeneranso kudziwa kuti kusintha kukuyembekezerani chithokomiro chanu panthawi yoyembekezera .

Chinthu china chofunika kwambiri: onetsetsani kuti vitamini wanu omwe ali ndi ubereki amakhala ndi ayodini, chofunikira kwambiri cha chithokomiro pa nthawi ya pakati.

Onani tsatanetsatane wa ndondomeko za Hyperothyroidism, Matenda a Hashimoto ndi Mimba .

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Zimene Mukuyenera Kudziwa Zokhudza Hyperthyroidism ndi Kumimba

Ngati muli ndi miyeso ya TSH yochepa-yeniyeni, muyenera kufufuza kuti mudziwe ngati chifukwa cha hyperthyroidism pa nthawi ya mimba ndi nthawi yayitali hyperthyroidism / hyperemesis gravidarum - vuto la mimba lomwe limayambitsa matenda aakulu a mmawa - kapena matenda a Graves . Matendawa amapangidwa pozindikira ngati muli ndi goiter, ndi / kapena kuyesa zowononga tizilombo toyambitsa matenda.

Ngati muli ndi pakati, ndipo mukhale hyperthyroid chifukwa cha matenda a manda kapena mitsempha, muyenera kuyamba mankhwala a hyperthyroidism nthawi yomweyo. Kawirikawiri, mungalandire chithandizo cha mankhwala osokoneza bongo (ngati mwatulukira kale), kapena, ngati mwakhala mukuchiritsidwa kale, mlingo wanu udzasinthidwa kotero kuti magulu anu a T4 omasuka athe kukhala osiyana ndi omwe alibe pakati.

Mankhwala oletsa tizilombo toyambitsa matenda (makamaka pa trimester yoyamba) ndi propylthiouracil, chifukwa methimazole ali ndi chiwopsezo chochepa (ngakhale chochepa) chomwe chimayambitsa zolepheretsa kubadwa mwa mwana wanu. Malangizowa amalimbikitsa kusintha kwa methimazole kwa trimesters yachiwiri ndi itatu .

Ngati muli ndi vuto lalikulu la mankhwala osokoneza bongo, muyenera kukhala ndi mlingo woyenera kwambiri kuti muzitha kuyambitsa hyperthyroidism, kapena musadziteteze ku hyperthyroidism ngakhale mukuchiritsidwa, opaleshoni ikhoza kukulimbikitsidwa . Kawirikawiri opaleshoniyi imalimbikitsidwa panthawi yanu yachiwiri ya trimester, pamene simungathe kuika mimba yanu pangozi.

Chofunika kwambiri: Chithandizo cha mankhwala a iodine sichiyenera kuperekedwa ngati muli kapena mutakhala ndi pakati.

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Zimene Mukuyenera Kudziwa Zokhudza Matenda a Chithokomiro, Graves 'ndi Newborn

Ngati muli ndi ma antibodies a TSH othandizira okhudzidwa ndi TSH kapena othandizira, amatha kuwoloka pansi, ndipo amakhudza chithokomiro cha mwana wanu. Ngati muli ndi kachilombo ka HIV pamatendawa, mwana wanu akhoza kubadwa ndi hyperthyroidism kapena hypothyroidism . Ma antibodies amenewa ayenera kulingalira ngati muli ndi Matenda a Graves, kapena ngati munakhalapo ndi ana omwe anabadwa ndi matenda a Graves. Zingakhalenso zofunikira kukupatsani mankhwala osokoneza bongo pamene muli ndi pakati kuti muchepetse chiopsezo kwa mwana wanu.

Ngati mwakweza ma antibodies a TSH othandizira-stimulating kapena stimulating receptor-ndipo amachizidwa ndi mankhwala osokoneza bongo, feteleza ultrasound kufufuza ayenera kuchitidwa. Izi zimapangitsa kuti chithandizo cha chithokomiro chisamayende bwino mwana wanu, kuphatikizapo kukula msanga komanso chithokomiro chowonjezera, pakati pa zizindikiro zina.

Ngati muli mayi watsopano ndi Matenda a Graves, mwana wanu wakhanda ayenera kuyesedwa kuti asamayambitse chithandizo cha chithokomiro atatha kubadwa, popeza pali chiopsezo chodziwika kuti neonatal hyperthyroidism: chomwe chiri ndi zotsatira za maselo a mwanayo .

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Zimene Mukuyenera Kudziwa Zokhudza Matenda a Mmawa ndi Hyperthyroidism mu Mimba

Azimayi onse apakati omwe ali ndi hyperemesis gravidarum (matenda aakulu a m'mawa omwe akuphatikizapo kutaya thupi kwambiri ndi kuchepa kwa madzi) ayenera kukhala ndi chithokomiro choyesedwa.

Ngati muli ndi matenda akuluakulu a m'mawa, komanso odwala hyperthyroidism chifukwa cha matenda a Graves, ndi hyperthyroidism yokhala ndi masewera olimbitsa thupi omwe ali ndi mahomoni ambiri a chithokomiro - opanda T4 pamwamba pa zolembera ndi TSH zosakwana 0.1 μU / ml - mungafunike chithandizo cham'chidule ndi mankhwala osokoneza bongo.

Phunzirani zambiri za nthawi yayitali ya hyperthyroidism / hyperemesis gravidarum .

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Zimene Mukuyenera Kudziwa Zokhudza Matenda a Chithokomiro ndi Khansara ya Chithokomiro M'kugona

Malingana ndi Malangizo, ngati muli ndi pakati ndipo muli ndi chithokomiro, muyenera kukhala ndi TSH ndi Free T4. Ngati muli ndi mbiri ya banja la medullary thyroid carcinoma kapena multiple endocrine neoplasia (MEN) 2, mawerengero a calcitonin ayenera kuyesedwa.

Malangizowa amalimbikitsanso ultrasound kuti adziwe zomwe zimachitika pa nodules, ndikuyang'ana kukula. Ngati nkhonoyi ili yosachepera 10mm muyeso, chida chabwino cha singano (FNA) biopsy ya chithokomiro chanu sichifunikira pokhapokha pali zizindikiro zokayikira.

Ngati nkhono ikukula, kapena muli ndi chifuwa chokhazikika kapena mavuto a mawu, kapena zizindikiro zina zokayikitsa za mbiriyakale, malangizowa amalimbikitsa kuti FNA ichitike. FNA imaonedwa ngati yotetezeka panthawi yoyembekezera.

Pamene chithokomiro cha khansa chikugwedezeka pakutha pa trimestre yoyamba kapena yachiwiri, opaleshoni iyenera kuperekedwa m'miyezi itatu yachiwiri. Matenda a kanseri osiyanitsidwa bwino kwambiri amakula pang'onopang'ono, kotero ngati kuwonetsa kukuwonetsa kuti khansara ndi papillary kapena follicular, ndipo palibe umboni wa matenda opatsirana, mukhoza kupatsidwa mwayi wodikira mpaka mwana wanu atabadwa asanachite opaleshoni.

Ngati muli pano ndipo mukupezeka ndi khansa ya chithokomiro, nthawi zina dokotala wanu amalimbikitsa kuyembekezera kufikira atabereka kwa opaleshoni. Koma mungathe kulandira mankhwala ndi mankhwala osokoneza bongo, kuteteza TSH yanu, koma ikawonekere. Momwemonso, T4 yanu yaulere kapena magulu onse a T4 ayenera kukhalabe mwachindunji cha mimba.

Iodine yopanda mavitamini sayenera kuperekedwa ngati panopa muli ndi pakati kapena mukuyamwitsa.

Mutalandira mankhwala ochizira a iodine, muyenera kuyembekezera miyezi isanu ndi umodzi kuti mukhale ndi pakati, kuonetsetsa kuti chithokomiro chanu chikhale cholimba, komanso kuti khansara yanu imakhala yakukhululukidwa.

Phunzirani zambiri za Matenda a Chithokomiro ndi Khansara ya Chithokomiro mu Mimba .

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Zimene Mukuyenera Kudziwa Zokhudza Matenda a Chithokomiro Chotsatira Pambuyo Patha

Ngati muli ndi mbiri ya postpartum thyroiditis , muli ndi chiopsezo chachikulu chokhala ndi hypothyroidism. Muyenera kukhala ndi chithokomiro chaka ndi chaka.

Kawirikawiri, mankhwala osokoneza bongo sagwiritsidwa ntchito pa nthawi ya hyperthyroid ya postpartum thyroiditis. Ngati muli ndi postroidum thyroiditis ndipo muli chizindikiro, beta blocker ingagwiritsidwe ntchito. Choyimitsa beta chovomerezeka ndi propranolol, pa mlingo wotsika kwambiri kuti athetse zizindikiro.

Malangizowo amavomereza kuti mutatha gawo lanu la hyperthyroid, TSH yanu iyenera kuyang'aniridwa miyezi iwiri iliyonse mpaka chaka chimodzi chotsatira pambuyo, kubwereza kuti hypothyroidism.

Ngati zizindikiro zanu ziri zovuta, kapena ngati mukukonzekera kutenga pakati, hypothyroidism yomwe imayambitsidwa ndi postpartum thyroiditis iyenera kuchiritsidwa. Ngati muli oyenerera, malangizowa amalimbikitsa kuti TSH yanu iwonongeke masabata onse anayi kapena asanu ndi atatu.

Ngati hyperthyroidism ikuwonekera mukakhala ndi mimba, malangizowa amalimbikitsa kuti hyperthyroidism ichitsidwe, koma limalimbikitsa kuti ngati chofunikira, kusankha mankhwala koyamba kumakhala mankhwala otchedwa anthimazole (dzina lakuti Tapazole). Mlingo wokwana 20 mpaka 30 mg / d umatetezedwa kwa mayi woyamwitsa ndi mwana wake. Chisankho chachiwiri cha mankhwala a antithyroid pambuyo pa mimba ndi propylthiouracil (yotchedwa PTU), pa mlingo wa 300mg / d. Akatswiri ali ndi nkhawa zambiri zokhudza kugwiritsidwa ntchito kwa PTU chifukwa cha matenda a chiwindi omwe amapezeka ndi mankhwala.

Ngati mukuyamwitsa ndikugwiritsa ntchito mankhwala osokoneza bongo, malangizowa amavomereza kuti mankhwala a antithroroid amagawidwe, ndipo amatengedwa nthawi zina zomwe zimachitika mukamayamwitsa. Ngati mukugwiritsa ntchito mankhwala osokoneza bongo komanso kuyamwitsa, mwana wanu ayenera kuyang'ananso nthawi zonse ndi mayesero a ntchito ya chithokomiro, malinga ndi Malangizo.

Kuti mudziwe zambiri, onani:

• Postpartum Thyrotoxicosis / Hyperthyroidism
• Postpartum Thyroiditis

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Zimene Mukuyenera Kudziwa Zokhudza Kuyamwitsa Ndi Matenda a Chithokomiro

Amayi ambiri atsopano amasankha kunyamwitsa. Ngati muli ndi vuto la chithokomiro, mungadabwe za chitetezo cha kuyamwitsa.

Ngati mukupatsidwa chithandizo cha hypothyroidism mukamayamwitsa , mungathe kupitirizabe kumwa mankhwala opangidwa ndi chithokomiro pamatenda anu oyenera popanda kuvulaza mwana wanu .

Funso la kutenga mankhwala osokoneza bongo chifukwa cha hyperthyroidism pamene akuyamwitsa ndizovuta kwambiri, ndipo mungafune kufufuza zomwe zikupindulitsa komanso zopitirira.

Muyeneranso kudziwa zotsatila ndi zowonjezereka zokhudzana ndi momwe mungatetezere chithokomiro mosamala pamene mukuyamwitsa .

> Chitsime:

> Stagnaro-Green, Alex, ndi. al. "Malangizo a Association of American Thyroid Association kuti Apeze Matenda ndi Kusamalira Matenda a Chithokomiro Pakati pa Mimba ndi Postpartum." Chithokomiro . Vesi 21, Nambala 10, 2011 (Online)