Kuyang'ana Natural Thyroid, Levothyroxine, ndi New New Treatment Options
Wofufuza wotchuka Dr. Wilmar Wiersinga, m'magazini ya zachipatala cha Januari 2014, yotchedwa Nature Reviews Endocrinology , ali ndi chidwi chochititsa chidwi cha zina mwazikuluzikulu zamagetsi zojambulidwa m'thupi la chithokomiro chotchedwa hypothyroidism m'zaka zaposachedwapa. Ndaphatikizapo mwachidule mbali zochititsa chidwi kwambiri mu nkhaniyi.
Zosintha Zina za Paradigm
Dr. Wiersinga akudziwitsa kusintha kwapadera kwazithunzi zinayi.
- Choyamba Paradigm Kusintha: Hysyothyroidism inali yosatetezeka mpaka mu 1891 ku London, Dr. George Murray anasintha kwambiri hypothyroidism mwa wodwalayo mwa kupereka jekeseni wa khungu la khungu la nkhosa. Kenako, tizilombo toyambitsa matenda kapena tizilombo ta tizilombo ta tizilombo ta tizilombo toyambitsa matenda tinayamba kugwiritsa ntchito monga mankhwala oyamba opangira chithandizo cha hypothyroidism.
- Njira Yachiwiri Yokwera Paradigm: Kuchokera mu 1960 mpaka 1988, kugwiritsa ntchito mankhwala osokoneza bongo omwe amadziwika ndi chilengedwe kunachepa pang'onopang'ono, momwe ntchito ya levothyroxine inkawonjezeka. Mu 1978, chiwerengero cha mankhwala a levothyroxine chinaposa zolemba zachilengedwe. Pofika mu 1988, 84 peresenti ya odwala onse anali kutenga levothyroxine.
- Njira yachitatu ya Paradigm Shift: Dr Wiersinga akufotokozera momwe zinyama zayesera kuyambira zaka za m'ma 1990 zasonyeza kuti euthyroidism - kukwaniritsa matenda a T4 ndi T3 m'magulu a thupi - pambuyo pochotsa chithandizo cha chithokomiro sichikanapezeka pa levothyroxine kokha, komanso amafunikira liothyronine (T3) . Odwala ndi odwala adalengeza odwala akuchita bwino ndi kuwonjezeka kwa T3, kapena pa chithokomiro chodziwika bwino , koma ambiri mwa mayesero ndi kafukufuku amene anachitidwa panthawiyi sanapeze kuti mankhwalawa ndi apamwamba. Dr. Wiersinga akuwonetsa kuti pali mitundu yambiri yomwe imapangitsa odwala ena kukhala omvera chifukwa cha mankhwalawa - ndipo amati "ngati maphunziro apadera angadziwitse gululi la odwala hypothyroid, kusintha kwachitatu kwa chithandizo cha hypothyroidism kungakhaleko kugwiritsa ntchito mankhwala ovomerezeka payekha pamtunda uwu. "
- Kusintha kwa Paradigm Yachinayi : Kafukufuku wopanga kafukufuku wa 2012 omwe adafotokozedwa kwa nthawi yoyamba kuti matenda a chithokomiro amatha kupangidwa kuchokera ku maselo oyambira a embryonic. Dr. Wiersinga akufotokoza kuti "ntchitoyi ikhoza kutsogolera kusinthika kwachinayi, komwe odwala matenda a hypothyroid angathe kuchiritsidwa ndi maselo opangira chithokomiro."
Levothyroxine Chithandizo Chake Chokha
Pokambirana za kusintha kwa paradigm, Dr. Wiersinga adayang'anitsitsa ntchito ya levothyroxine (T4) yokha . Iye adanena kuti pali maphunziro angapo omwe amasonyeza kuti mankhwala a levothyroxine akukhudzana ndi mavuto ambiri kwa odwala, kuphatikizapo:
- kuwonjezeka kwa maganizo
- kusokoneza ubwino
- kuchepa kwa umoyo wokhudzana ndi thanzi
- Kusokonezeka kwa chidziwitso chofulumira, chidwi, kuphunzira ndi kukumbukira
- kuchuluka kwa nkhawa
- ntchito yamaganizo yosautsika, kugwira ntchito kukumbukira ndi kuphunzira
Makamaka, malinga ndi Dr. Wiersinga, "Odwala matenda osokonezeka maganizo, ovutika maganizo kapena okhumudwa amawonedwa pakati pa 5-10% a odwala hypothyroid omwe amalandira levothyroxine, ngakhale kuti ali ndi TSH ."
Dr. Wiersinga akufotokozanso za chidwi cha Scottish chomwe chinapeza kuti mavuto a mtima, arrhythmias, ndi fupa lazowonjezereka zawonjezeka kwa odwala omwe ali ndi ngongole ya TSH (osachepera003), komanso odwala omwe ali ndi miyeso yapamwamba ya TSH (pamwamba pa 4.0) koma panalibe chiopsezo chowonjezeka chokhudzana ndi ma "TSH" otsika "(otsika") a TSH ((04 to .4).
Dr. Wiersinga anapeza kafukufuku amene amasonyeza kuti "maselo a TSH omwe sakhala otsimikiza kuti ndi euthyroidism m'zinthu zonse zomwe zimayambitsa mahomoni a chithokomiro." Mwachidule: mankhwala a levothyroxine okhawo sangakhale abwino kwambiri kwa odwala omwe ali ndi hypothyroidism. M'malo mwake, kuwonjezerapo kwa t3 kungathandize kuonetsetsa kuti chithokomiro chimagwira ntchito m'zinthu zonse.
Levothyroxine Wophatikizapo Liothyroinine (T4 + T3)
Maphunziro angapo akuyang'ana mankhwala a levothyroxine okha, kuphatikizapo kuwonjezera kwa T3 asonyeza kuti, malinga ndi Dr. Wiersinga, "chiŵerengero chachikulu cha odwala (pafupifupi 48%) chinasankha mankhwala othandizira ... Kusiyanasiyana kwa seramu yomalizira Maseŵera a TSH sakanatha kufotokoza zofuna za wodwalayo. "
Zotsatira
Dr. Wiersinga amatsimikizira kuti "lingaliro lovomerezeka lingagwiritsidwe ntchito kuti mankhwala ophatikizanawo angakhale opindulitsa ngati levothyroxine: liothyronine dose ratios yomwe ikugwiritsidwa ntchito yomwe imapangitsa kuti maselo a TSH akhale ofanana ndi a T4: kumasulira kwa T3 kwaulere" kapena pamene aperekedwa kwa odwala omwe ali Matenda omwe amachititsa kuti athe kusintha T4 mpaka T3.
Amalimbikitsanso kuti mapulotinolojekiti ayenera kuyang'ana pazochita, kuphatikizapo Kuwonjezera kwa T3, kuthandiza odwala hypothyroid omwe ali ndi zizindikiro zosayembekezereka ngakhale kuti ali ndi mankhwala okwanira a levothyroxine.
Malingana ndi Dr. Wiersinga, njira imodzi ndiyo kutsatira malangizo a European Thyroid Association (ETA) pa zomwe amati "kuyesera" kugwiritsa ntchito mankhwala a T4 + T3 , omwe amachititsa chiŵerengero cha levothyroxine kufika ku liothyronine cha pafupi 17: 1 Malinga ndi nkhaniyi, "mwachitsanzo, TSH-normalizing levothyroxine mlingo wa 100 μg, 150 μg ndi 200 μg pa monotherapy kutanthauzira ku mankhwala owonjezera a 85 μg levothyroxine kuphatikizapo 5 μg liothyronine, 125 μg levothyroxine komanso 7.5 μg liothyronine ndi 175 μg levothyroxine komanso 10 μg liothyronine, motero).
Amalimbikitsanso kupatula mlingo wa T3 tsiku ndi tsiku (mlingo waing'ono woperekedwa m'mawa ndi mlingo waukulu womwe umaperekedwa pa nthawi yogona, zofanana kwenikweni malinga ndi zomwe zikupezeka m'kati mwake). "Kuthandiza kutsanzira chizunguliro cha circadian Maseŵera a T3 omasuka, omwe amafika pachimake pa 3 koloko "
ETA imalimbikitsanso kukonzekera pang'ono kutsegulira T3.
Mfundo Zina Zochititsa Chidwi
Nazi mfundo zina zochepa zomwe zimapezeka kuchokera ku nkhaniyi.
Malangizo othandizira mankhwala a hypothyroidism omwe anafalitsidwa m'zaka za m'ma 1980 ndi 1990, "mosaganizira" amalimbikitsa levothyroxine (yokonza T4) ndipo samatchula njira zina zothandizira odwala. Chokondweretsa, malangizo onse a hypothyroidism omwe amalembedwa m'ma 2000s amalimbikitsanso levothyroxine ngati mankhwala ochiritsira, komanso ali ndi zigawo zotsutsa chifukwa chake kuphatikiza mankhwala a levothyroxine ndi liothyronine (T4 + T3) omwe sagwiritsidwe ntchito sayenera kugwiritsidwa ntchito.
Pali kuwonjezeka kwa mankhwala a hypothyroidism. Ku England, mayendedwe a mahomoni a chithokomiro awonjezeka kaŵirikaŵiri pakati pa 1998 ndi 2007. Ku Netherlands, chiŵerengero cha anthu omwe akugwiritsa ntchito mankhwala a chithokomiro chinawonjezeka ndi 53% pakati pa 2005-2011 - anthu a ku Dutch anawonjezeka ndi 2.1% panthawi imeneyo.
Chiwerengero cha odwala omwe ali pa levothyroxine-okha chithandizo chamachepetsedwa pang'ono kuchokera mu 2005 mpaka 2011 - ndipo pakhala kuwonjezeka pang'ono kwa chiwerengero cha odwala opanga mankhwala a T4 + T3.
Kuchokera
Wiersinga, Wilmar. "Kusintha kwa paradigm m'matenda a chithokomiro m'malo ochizira matenda a hypothyroidism." Nature Review Endocrinology (2014), Lofalitsidwa pa Intaneti 14 January 2014