Chithandizo cha Chithokomiro cha Hypothyroidism
Nkhani zabwino za odwala chithokomiro: kafukufuku wofalitsidwa m'nyuzipepala yotchuka kwambiri yotchedwa endocrinology, inanena kuti kuphatikiza kwa T4 / T3 ndiposa T4 yekha / levothyroxine mankhwala a hypothyroidism! Nazi zinthu zambiri.
Phunziro la groundbreaking linafotokozedwa mu European Journal of Endocrinology kuyang'ana nkhani yothetsera vuto ndi mankhwala T3 monga chowonjezera ku T4-yekha (levothyroxine) therapy kwa hypothyroidism.
Kafukufuku wina wobwereranso zaka zoposa khumi asonyeza kukula kwa mankhwalawa. Maphunziro ena, komabe sanapeze kusiyana kulikonse. Kusagwirizana kwa kafukufukuyu pa T3 kwachititsa akatswiri ena - makamaka omwe amatsutsana ndi levothyroxine-okha mankhwala - kuganiza kuti palibe phindu kuwonjezera T3. (Ena mwa "akatswiri" omwewo adapanga chidziwitso chachikulu, ndipo anaganiza molakwa kuti levothyroxine / T4-mankhwala okhawo ndi apamwamba kuposa mankhwala a T4 / T3.)
Mulimonsemo, mufukufuku, ofufuza a ku Danish adafufuza mobwerezabwereza kupyolera mwapadera - zomwe zimaonedwa kuti ndizogolidi zapamwamba za kafukufuku - odwala 59. Mu gulu la odwala, 50 micrograms ya chiwerengero cha T4 chizolowezi chinasinthidwa ndi 20 mcg ya T3 kapena 50 mcg ya T4 kwa masabata 12. Odwalawo anachita "kuwoloka," akuchita zosiyana kwa milungu ina 12.
Mlingo wa T4 unayendetsedwa ngati pakufunika kuti ma TSH akhale otetezeka.
Mayesero kuti akhale ndi moyo wabwino (QOL) ndi kukhumudwa kunayambika pachiyambi, ndipo patatha masabata awiri onsewa. Makhalidwe a moyo ndi maganizo omwe adayesedwa akuphatikizidwa, mwazifukwa zina: zokhudzana ndi thanzi labwino, chikhalidwe cha anthu, thanzi labwino, umoyo, kukhudzidwa, kuvutika maganizo, ndi nkhawa.
Chimene ofufuza apeza chinali chakuti pakati pa odwala - 55 mwa iwo anali akazi - panali kusiyana kwakukulu pakati pa 7 pa 11 a QOL ndi mawerengero ovutika maganizo, kusonyeza zotsatira zabwino zokhudzana ndi mankhwala ophatikizidwa T4 / T3.
Onse okwana 49% adakonda kusakanikirana, ndipo 15% okha amangofuna mankhwala a levothyroxine okha.
Ofufuzawo anapeza kuti, mu kafukufuku komwe mazinga a TSH amakhala osasinthasintha, mankhwala okhudzana ndi T4 / T3 omwe analipo 20 mcg a T3 tsiku ndi tsiku anali apamwamba kuposa mankhwala a levothyroxine okha, poyesa miyezo yambiri ya moyo, kuvutika maganizo ndi nkhawa mamba, ndi zofuna zoleza mtima.
Nthawi zambiri madokotala amanena za chiopsezo cha zotsatirapo ndi mankhwala a T3 monga chifukwa chosagwiritsira ntchito T3, koma phunziro ili linasonyeza kuti panalibe kusiyana pakati pa zotsatira. Malingana ndi olembawo, panthawi ya mankhwala a T4 / T3, anthu asanu adakumanapo ndi zotsatira zoyipa monga kuphwanya, kutukuta kwambiri, ndi kusagwirizana maganizo. Pakati pa mankhwala a T4 okha, anthu asanu ndi anayi adanena zotsatira zofanana.
N'zochititsa chidwi kuti akatswiri a ku Denmark anafotokoza mavuto omwe anapezapo pa maphunziro a T4 / T3 omwe sanapeze phindu lililonse pa chithandizo cha T3, akuti: "Maphunziro omwe anaphatikizidwa pa meta anali osakaniza a magulu osiyanasiyana odwala, kuphatikizapo odwala ndi khansa yam'mbuyo yam'mbuyo, autoimmune hypothyroidism, ndi subclinical komanso ma hypothyroidism. "
Ndipo, malinga ndi akatswiri ofufuza a Danish, mu imodzi mwa maphunziro ofunikira, "... [olemba] sankatha kusunga maseŵero a TSH a serum omwe ali ofanana m'magulu awiri achipatala, amatanthawuza kuti serum TSH ikhale itatu mu gulu limodzi 1.5 mU / l mu gulu la monotherapy.
Ofufuzawo akuti maphunziro awo akusonyeza kuti gulu la odwala likuwoneka kuti limapindula ndi mankhwala ophatikizidwa a T4 / T3. Makamaka, iwo amasonyeza kuti pangakhale zifukwa za physiologic chifukwa chomwe gululi likuyankha-kapena zosowa - T3, makamaka, kuti:
... polymorphism yomwe imapezeka posachedwapa mu jini yolemba mtundu wa two deiodinase, mavitamini omwe amachititsa kuti T3 iyambe kupezeka ku ziphuphu, zakonzedwa kuti zithandize kuzindikira magulu ang'onoang'ono omwe angapindule ndi mankhwala okhudzana ndi T4 / T3. Pulomorphism inanso, yomwe ili ku OATP1C1, imatulutsa timadzi timene timatulutsa magazi m'maganizo, timakhala ndikutopa komanso kukhumudwa.
Wilmar Wiersinga, yemwe ali ndi njala ku West Endocrinologist, adanena kuti: "Titha kukhala abwino kwambiri, anthu ena akhoza kukhala ndi mavitamini kuti azichita bwino pa T3
Wilmar Wiersinga, yemwe ndi katswiri wa zachipatala ku Netherlands, analemba zolembazo, "Kodi tikusowa mayesero ambiri pa T4 ndi T3 mankhwala othandizira mu hypothyroidism?"
Malingana ndi Dr. Wiersinga, kafukufuku wina wakale adazindikira kuti palibe phindu lowonjezera T3. Komabe, popeza kuti, malinga ndi Wiersinga, pafupifupi 10 peresenti ya odwala hypothyroid sakhutira ndi momwe amamvera pa zomwe madokotala amatcha "mlingo woyenera" wa levothyroxine m'malo mwake anawatsogolera kufalitsa maphunziro a Danish.
Mkonzi, womwe umafalitsidwa pa intaneti yonse, umatchula zolakwika m'maphunziro akale ndi kafukufuku wothandizana ndi T4 / T3. Dr. Wiersinga amatsimikizira kuti pali zifukwa zikuluzikulu ziwiri zochitira mayesero owonjezera omwe amachititsa kuti awononge levothyroxine / T4 okha mankhwala monotherapy, ku T4 / T3 mankhwala othandizira:
Choyamba, mayesero mpaka pano sakhala opambana potengera thupi la serum FT4-FT3 ratios mu 24 h. Kukonzekera kwamasulidwe okonzeka T3 kungakhale kofunikira kuti tikwaniritse cholinga cha 'thupi' m'malo mwa mahomoni. Chachiŵiri, kuchulukitsa kwa ma polymorphisms mu mafinysi ndi chithokomiro cha othamanga timatenda timagwirizanitsa ndi ubwino wa maganizo, kupsinjika maganizo, kutopa, ndi kukonda mankhwala othandizira. Kodi zikhoza kukhala kuti maphunziro osakhutitsidwa ndi monotherapy ndi omwe amanyamula kawirikawiri ma polymorphisms, ndipo adzakhala ndi njira yabwino yothetsera mankhwala osakaniza?
Malingana ndi Dr. Wiersinga, kupititsa patsogolo kukonzekera kwa T3, komwe kumaperekedwa ngati mlingo umodzi wa usiku (pamodzi ndi levothyroxine kamodzi tsiku ndi tsiku) kungapitirizebe kusunga mgwirizano waumoyo wa Free T4 ndi Free T3 ena odwala chithokomiro pa ora la 24.
Zindikirani: Kotero tiyeni tibwerezenso izi. Theka la odwala ankakonda kugwirizana kwa T4 / T3 - 15% okha ankakonda levothyroxine yekha, ndipo, umoyo wa moyo ndi zinthu zina zinasintha. Ndipo, mankhwala a T4 / T3 analibe zotsatira zina kuposa T4-yekha. (Ndipotu, mu phunziro ili, T4-mankhwala okha anachititsa zina zambiri zotsatira.) Ndikuyembekezera kuti ena ofanana otchedwa katswiri wa chithokomiro - amene nthawi zambiri ali pa malipiro kwa levothyroxine opanga - mwina kupita amadzigwetseratu akuyesera kufotokozera zomwe zapeza, ndipo zimakhala zokondweretsa kuziyesa!
Nkhani yeniyeni ya magazini yonseyi ndi kuwerenga kochititsa chidwi, koma mwatsoka, sikuyikidwa pa intaneti. Koma mukhoza kugula pa Intaneti pa $ 25 pa webusaiti ya European Journal ya Endocrinology . Ichi ndi chimodzi chimene mukufuna kuti dokotala aziwerenganso, choncho onetsetsani kuti mumuuzeni kuti apezenso bukuli. Kunena zoona, kungakhale koyenera kugula kopereka kwa Dokotala, ngati sakufuna kuphunzira za chitukuko.
Zambiri Zokhudza T4-Vesi Yekha. T4 / T3 Chithandizo cha Mgwirizano wa Hypothyroidism
- Kuwoneka pa T4 Yekha ndi Mtsutso wa T4 / T3 Woledzera
- T3 Triiodothyronine Mankhwala Osokoneza Bongo Amalimbitsa Ubwino Wamoyo kwa Hypothyroidism: Kafukufuku Amapeza Odwala Ambiri Amamva Bwino Powonjezera T3 / New England Journal of Medicine Study of 1999
- Kuphunzira Kumapeza Odwala Amaphatikizapo Mgwirizano T4 / T3 Chithandizo: Mawonetsero a Kafukufuku Combo Therapy Okhudzana ndi Kulemera Kwambiri / 2005
> Zotsatira:
> Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny, Anne Jarløv ndi Jens Faber. "Mmene Mungagwiritsire Ntchito Mmene Mungagwirizane ndi Thyroxine (T4) ndi 3,5,3'-Triiodothyronine Versus T4 Monotherapy kwa Odwala ndi Hypothyroidism, Phunziro Lachiwiri lopanda Phungu," European Journal of Endocrinology , Vol. 161, Magazini 6, 895-902, December 2009 Chosavuta, (Full text ($ 25))
> Wiersinga, Wilmar "Kodi Timafunikira Zowonjezereka Zambiri pa T4 ndi T3 Therapy mu Hypothyroidism?" European Journal of Endocrinology , Vol. 161, Nkhani 6, 955-959. Nkhani yonse (yaulere)