Dr. Theodore C. Friedman, MD, Ph.D. ndi Pulofesa Wothandizira wa Zamagetsi-UCLA, Endocrinology Division, ndipo ali wothandizira zachipatala payekha. Kuti mumve zambiri zokhudza zomwe amachita, onani www.goodhormonehealth.com.
M'nkhaniyi, akuganiziranso za matenda a hypothyroidism ndi mankhwala.
Matenda a Hypothyroidism
Hypothyroidism ndi matenda ofala kwambiri.
Zimakhudza amai ambiri ndiye amuna, koma ndimapezeka kuti ndine mmodzi mwa amuna omwe ali nawo. Zizindikiro za hypothyroidism zimaphatikizapo kutopa, kupweteka kwapang'onopang'ono, kudzimbidwa, kupweteka kwa minofu, kupweteka pamodzi , kumverera ozizira, kusamba, kusamba tsitsi , khungu, ozizira komanso nthawi yochepa. Odwala ambiri adzakhala ndi goiter (chithokomiro chowonjezera). Ngakhale kuti adakambirana zambiri, ndikukhulupirira kutentha kwa thupi sizitsimikizirika za hypothyroidism.
Chiŵerengero cha hypothyroidism chimakula ndi kukula kwa msinkhu. Mwa kuyankhula kwina, okalamba timapeza, vuto lalikulu la chithokomiro lidzaonekera. Chifukwa chofala kwambiri cha hypothyroidism ( hypothyroidism chochokera ku chithokomiro chokha), ndi Hashimoto's Thyroiditis. Hashimoto ndi chikhalidwe chokha . Matenda a thupi omwe amachititsa khungu la chithokomiro ndi kuliwononga, motsogolere ku hypothyroidism. Hashimoto's Thyroiditis angakhale chiwonetsero cha multiple symmune syndromes ndipo zingachitike m'mabanja.
Tizilombo toyambitsa matenda tingathenso chifukwa cha vuto lalikulu (central hypothyroidism).
Kuzindikira mitundu yonse ya hypothyroidism n'kofunika, chifukwa chithandizo chamatenda a chithokomiro chidzapangitsa zizindikiro za odwala omwe ali ndi hypothyroidism, koma sangawathandize omwe alibe hypothyroidism. Poyambirira hypothyroidism, chithokomiro, chomwe chili pamtambo, sichikhoza kutulutsa mahomoni a chithokomiro , T4 ndi T3.
Mtundu wa pituitary, womwe uli pamutu, umayankha vutoli pobisa TSH zambiri. Choncho, mu nthawi zovuta kwambiri za hypothyroidism, ma T4 ndi T3 amakhala osowa, koma TSH ndi yaikulu. Pa milandu yovuta, T4 ndi T3 magulu akugwa. Ngakhale kuti nthawi zambiri TSH imakhala pakati pa 0,5 ndi 5 mU / mL, chidziwitso pamapeto pamtundu waukulu chikhoza kukhala chachilendo. T3 ndi horoni yochuluka kwambiri poyerekeza ndi T4, koma T4 ndi yolimba kwambiri pakufalitsidwa.
Njira yanga yodziwira matenda a hypothyroidism ndi kuyamba ndi mbiri yosamala komanso zakuthupi. Kenaka wogwira ntchito yotchedwa Endocrinologist amayenera kuyesa zitsulo kuti aone ngati wodwalayo ali ndi goiter. Magazi a TSH, T4 omasuka, T3 omasuka ndi ma anti-TPO ayenera kuyesedwa. Odwala omwe ali ndi chithokomiro chowonjezera ndi / kapena anti-TPO antibody test ndi TSH yaikulu kuposa 4.0 mU / mL ayenera kuganiziridwa kuti ali ndi hypothyroidism yoyamba. Odwala opanda chithokomiro chofutukuka komanso opanda mankhwala opambana ndi TPO antibody koma ali ndi TSH wamkulu kuposa 7.5 mU / mL ayenera kuganiziridwa kuti ali ndi hypothyroidism yoyamba. Odwala omwe ali ndi T4 osachepera oposa 0.9 mg / dL ndi TSH osachepera 1.0 mU / mL akhoza kukhala ndi pakati pa hypothyroidism. Odwala omwe ali ndi zizindikiro za hypothyroidism koma osatsata izi ayenera kuyang'ananso ndikubwezeretsanso mu miyezi isanu ndi umodzi.
Hypothyroidism Treatment
Pamene hypothyroidism imapezeka, pali njira zambiri zothandizira mankhwala , kuphatikizapo zokonzekera L-thyroxine (T4) (Synthroid, Levoxyl ndi Unithroid), zokonzekera L-triiodothyronine (T3) (Cytomel), kuphatikizapo T4 / T3 (Thyrolar) Kukonzekera kwa chithokomiro (Armor, Naturethroid, Bio-Throid, ndi Westhroid). Zonse za L-thyroxine zokonzekera zili ndi zofanana zomwe zimagwira ntchito, koma zili ndi zodzala zosiyanasiyana ndipo zimakhala ndi mphamvu zosiyana. Mpaka posachedwa, Synthroid inalibe FDA, koma tsopano zokonzekera L-thyroxine zili ndi FDA.
Thyrolar ndi zokonzedwa zowonongeka zokhudzana ndi chithokomiro mwina zimakhala ndi chiwerengero cha T3 / T4 choposa kuposa chofunika ndipo motero, nthawi zambiri ndimapereka ndalama zochepa zokonzekera zomwe zikuwonjezeredwa ndi T4.
Ambiri otchedwa endocrinologists amagwiritsa ntchito L-thyroxine kukonzekera kuchipatala koyambirira kwa mitundu yonse ya hypothyroidism. Ngakhale kuti ntchito ya L-thyroxine (T4) yofanana ndi L-triiodothyronine (T3) ingakhale yodabwitsa ngati T3 ndi mahomoni ambiri a chithokomiro, T4 amagwiritsidwa ntchito nthawi zambiri. Izi ndi chifukwa matenda amasintha T4 kufika ku T3 kuti akhalebe ndi thupi la T3. Choncho, kayendetsedwe ka T4 imayambitsa T3 ndi T4. Pamene T4 imakhala yodalirika kuposa T3, T4 mankhwala amapereka ngakhale m'magazi, pamene mankhwala a T3 amapita kumatenda apamwamba atatha kumwa mankhwala ndi kuchepa kwa mlingo wotsatira. Kuteteza chithokomiro ndi kukonzekera kochepa kwambiri. Chifukwa chakuti chithokomiro chimatulutsa ma chithokomiro a nkhumba, ena a Endocrinologists amakhulupirira kuti pali mapiritsi apamwamba pa mapiritsi, koma izi sizingakhale zoona.
Kafukufuku amene adafalitsidwa ku New England Journal of Medicine mu 1999 adanena kuti ubongo wa T4 ku T3 ungasokoneze odwala ena ndipo gulu la odwala liyenera kuchitidwa ndi T4 ndi T3 . Kafukufuku wina wofalitsidwa mu Journal of Clinical Endocrinology ndi Metabolism mu 2003 ( onani nkhani ino ) akuwonetsa kuti Kuwonjezera kwa mankhwala a T3 mpaka T4 sikufunika kwa odwala ambiri omwe ali ndi hypothyroidism. Ndikulangiza kuti odwala ambiri ayambe kukonzekera T4, zomwe zimapangitsa kuti zizindikiro zikhale bwino kwa odwala ambiri. Ndapeza kuti odwala ambiri amakonda Levoxyl kapena Unithroid kuti Synthroid , koma izi zimasiyana ndi wodwala aliyense. Nditatha kuchipatala ndi T4, ndimasintha mlingo wawo wa T4 mpaka TSH ili pakati pa 0,5 ndi 2 mU / mL. Ngati atakhalabe ndi zizindikiro ngakhale kuti ali ndi TSH yabwino, ndiye kuti T3 yomwe imaperekedwa kawiri kapena katatu patsiku imatha kuwonjezeredwa ku T4. Ngati odwala amayamba ndi gawo lochepa lamasamba la T3, ndiye kuti ndikuwathandiza kwambiri ndi T4 pamodzi ndi T3. Pa T4 kuphatikizapo mankhwala a T3 , ndimagwiritsa ntchito mayeso a magazi kuti ndiwonetsetse kuti T4 yaulere komanso T3 omasuka ali pamtundu wapamwamba. Mtengo wa TSH nthawi zambiri umachotsedwa pothandizidwa pamodzi .
Peresenti ya odwala adzakhala ndi kusintha kwachidziwitso pa T4 kuphatikizapo mankhwala a T3. Kwa iwo omwe samasintha, nthawi zina ndimapereka chithandizo ndi mankhwala okonzedwanso a chithokomiro, nthawi zambiri Zida, kuphatikizapo kupanga T4. Kuphatikizana kumeneku kumafunika ngati mazokonzedwe a chithokomiro otchulidwa amakhala oposa T3 / T4 kuposa momwe amafunira ndipo amafunika kuwonjezeredwa ndi kupanga T4 kuti akwaniritse mitsempha yonse ya mahomoni onse. Apanso, ndimayesetsa kuti ndikhale ndi T4 kwaulere komanso ndikumasula T3 kumtunda. Odwala omwe ali pakati pa hypothyroidism angathe kuchiritsidwa ndi njira iliyonse yokonzekera odwala ali ndi hypothyroidism. Kusiyanitsa ndiko kuti chithandizo chiyenera kuyang'aniridwa mwa cholinga chokhala ndi T4 kwaulere ndi T3 mfulu kumtunda wautali, monga TSH ikuchotsedwa ndi mankhwala oyenera. Odwala omwe ali pakati komanso oyambirira hypothyroidism amafunikanso kuchitidwa pofuna kulandira T4 yaulere ndi T3 omasuka pamtundu wapamwamba. Ndinawapeza ndi primary hypothyroidism mu February 2003. Wophunzira za sayansi yamakono anachita kafukufuku wa chithokomiro changa ndipo ndinapezeka kuti ndiri ndi goiter. Magazi anga amasonyeza TSH ya 8 mU / mL ndipo amatsutsa kwambiri anti-TPO. Ndili ndi mbiri yakale ya banja la Hashimotos Thyroiditis koma ndinali ndi mwayi wokhala ndi mankhwala osakanizidwa chisanafike chithandizo. Panopa ndili pa 150 mg tsiku la Levoxyl, muli ndi TSH ya 1.9 mU / mL ndipo mumamva bwino. Ndataya mapepala ochepa pa mankhwala a T4 ndipo mbiri yanga ya cholesterol yakula bwino.
Choyamba chinasindikizidwa pa intaneti, 2003